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8/22/2019 Spinal Tuberculosis (Potts Disease)
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Spinal Tuberculosis
(Potts Disease).
Kiking Ritarwan
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Sinonim
Potts disease
Davids disease
Angular kyphosis Kyposis secondary to tuberculosis
Tuberculosis of the spine
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The first found Pervicall Pott (England,1779),triad of potts disease: abscess, gibuss,paraplegia
Single or multiple vertebral involvement bytuberculosis is frequently followed by spinalcord compression due to development of
cold abscess in epidural space (Pottdisease)
The most common site of infection isthoracolumbar spine, rarely cervical spine.
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ANATOMI VERTEBRA
ANATOMI VERTEBRAP ro c . M a
s t o id
A t la s
A x is
P ro c e s s u ss p in o s u s D is k u s In t e r v e r t
C o rp u s v e r tC 7
TH1
T h 1
T h 1 2
L 1S p in a l n e r v e
M a n d ib u laC 1
C 2
P e lv ic C u r v a t u r a
P ro m o n t o r y
D is c I n t e r v e r t
N u k le u s P u l p o s u s
C o rp u sv e r t e b ra
C o rp u s v e r t e b ra
W E IG H T
P
ro c S p in o s u s
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Lokasi
Spondilitis TB
1.Paradiscal type >
2. Central type
3. Anterior type
4. Post Facet joint
5. Appendicial
1
2
4
3
1
5
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Spondilitis Tuberkulosa
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Pathogenese
Begin from existence of primary focus outside vertebra[ extrapulmoner], later;then disseminate by hematogen tovertebra and usually [regarding/ hit] part of corpus vertebraeanterior at elbow intervertebralis discus.
Peaky earn happened just where as long as vertebra, but atmost [at] mid and under thoracalis vertebra and lumbalvertebra.
Can [regarding/ hit] one segment or some vertebra segment.[At] the place can happened cheese that happened effect offorming [of] granulasi network and destruction on corpus
vertebra little by little from anterior to posterior. This Destruksi can generate anguler gibbus. Besides also earn
also happened " Cool abscess [ Cold Abcess]. Most [is] oftenmet [by] cool [by] abscess [at] thorakal vertebra 8 until lumbal 3.
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Patofisiologi Spondilitis Tuberkulosa
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Patofisiologi
Rute Penyebaran ke
Vertebra :
Arteri/hematogen
Vena (batson plexus)
Percontinuitatum
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Clinical manifestasion
Back Pain (79%)
Paraparese (66%)
Kyphosis (52%) Fever (45%)
Sensory disturbances (34%)
Bowel and Bladder dysfunction (31%).
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Manifestasi Klinis
Keadaan Umum
Sakit kronis, demam,
keringat malam, anorexia,
Penurunan berat badan Gejala Lokal
Nyeri lokal atau radikuler
Spasme otot punggung
night cries pada anak
Defisit neurologis
Deformitas
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Manifestasi Klinis
Pemeriksaan Klinis Deformitas, gibbus
Spasme otot
paravertebral
Defisit neurologis
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Diagnostic procedure
Pemeriksaan darah : LED meninggi> 100mm/jam Tuberculin skin test (Purified Protein Derivative/ PPD)
biasanya positif Biopsi kelenjar leher Sputum utk BTA (+) dan kultur Mycobacterium tuberculosa
Radiologi- proses spesifik di paru Thorax foto
- Vertebra : gibbus dan kyphosis
- CT Scan Vertebra : destruksi vertebra, soft tissue calcification,narrow disc space, bone erosion(scalloping).
- MRI vertebra:
a. membedakan TB spondilitis atau pyogenic spondylitis,
b. melihat adanya kompresi saraf.
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Foto Rontgen
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CT Scan
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MRI
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Treatment
1. Immobilisasi, best rest total, extrafeeding, brace, korset 2. Antituberculous drugs
Berdasarkan Pedoman Penatalaksanaan TB paru:
termasuk kategori I ( TB diluar paru):
# 2 bln pertama : Streptomycin, INH, Rif dan PZA
# Bulan 3-12 : INH dan Rifampin
3. Operative
- Indikasi operasi pada potts disease:
adanya defisit neurologis
adanya abses paravertebra [Cold Abses]
terapi konservatif gagal
severe kyposcoliosis
cord/ nerve compression
- Tindakan bedah yang dilakukan:
requires anterior abscess drainage
anterior spinal arthrodesis.
posterior spinal arthrodesis.
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PROGNOSA
Dari 100 penderita ,yang mengalami
disability 2 penderita mengalami
reccurence paraplegia setelah 3 tahun
berobat, 1 penderita akibat granuloma
ekstramedularis dan 1 orang dengan
kifosis yang berat.
Angka mortalitas 20%.