Tuberculosis of Spine (Pott's Spine)

A comprehensive set of vocabulary flashcards covering the history, epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of spinal tuberculosis (Pott's Spine).

Percival Pott

The physician who in $1779$ provided the classical description of spinal tuberculosis as the "destruction of disc and adjacent vertebral bodies, collapse of spinal elements and progressive spinal deformity."

Robert Koch

The scientist who discovered Mycobacterium tuberculosis in $1882$, identifying the causative agent of the disease.

Thoracolumbar Junction

The most common site affected by skeletal tuberculosis, followed by the lumbar and then the cervical spine.

Paradiscal Lesion

The most common variety of vertebral lesion involving contiguous bony end plates and the intervening disc, which develop from the same sclerotome and share a blood supply.

Central Lesion

A type of vertebral lesion where infection starts in the center of the body, reaching it via Batson's venous plexus or branches of the posterior vertebral artery.

Anterior Lesion

A lesion where infection starts beneath the anterior longitudinal ligament and periosteum, showing erosion on lateral views; it is more common in the thoracic spine of children.

Posterior Lesion

Isolated involvement of the pedicle, lamina, transverse process, or spinous process, occurring in approximately $5\%$ of cases.

Night Cries

A symptom caused when muscle spasms relax during sleep, allowing movement of inflamed surfaces; it is more common in cervical or thoracic vertebral involvement.

Cold Abscess

A slow-growing abscess seen in $20\%$ of cases that spreads subligamentously along neurovascular bundles and myofascial planes without proteolytic enzymes.

Retropharyngeal Abscess

A type of cold abscess in the cervical spine that can result in symptoms such as dysphagia, hoarseness, and respiratory distress.

Pott's Paraplegia

Neurological deficit or paralysis caused by spinal cord compression or infarction due to inflammatory, mechanical, or intrinsic factors at the level of the involved vertebra.

Early Onset Paraplegia

Paraplegia occurring within $2$ years of disease onset during the active phase, typically caused by inflammatory edema or abscess; it generally has a good prognosis.

Late Onset Paraplegia

Paraplegia occurring more than $2$ years after disease onset, usually due to mechanical pressure from severe deformity or canal stenosis; it has a poor prognosis.

Kumar and Tuli Stage II

A mild severity of neurodeficit where the patient is aware of the deficit but can still walk with support.

Knuckle Deformity

A type of kyphotic deformity caused by the collapse of $1$ vertebra.

Gibbus

A kyphotic deformity resulting from the collapse of $2\text{--}3$ vertebrae.

Global Kyphosis

A spinal deformity involving the collapse of more than $3$ vertebrae.

Spine-at-risk Signs

Radiological indicators including retropulsion, subluxation of facet joints, lateral translation, and toppling that predict the development of severe late kyphosis.

Mantoux Test

A delayed hypersensitivity skin test where an induration of $>10\,mm$ at $72$ hours is considered positive, though it is non-diagnostic in endemic or immunodeficient states.

Tissue Biopsy

Considered the gold standard for the diagnosis of spinal tuberculosis, often performed via CT or fluoroscopic guidance.

Roentgen Triad

The classic X-ray signs of spinal TB consisting of a primary vertebral lesion, disc space narrowing, and paravertebral abscess.

Skipped Lesions

Multiple tuberculous lesions separated by one or more healthy vertebrae, occurring in about $7\%$ of cases.

Hong Kong Technique

A surgical approach involving anterior debridement and fusion via a transpleural anterolateral approach, originally advocated by Hodgson and Stock in $1956$.

Middle Path Regime

A treatment approach developed by Prof. S.M. Tuli in the 1960s involving triple agent chemotherapy, nutritional optimization, and surgery only for specific indications.

Intensive Phase (3HRZE)

A standard $3$-month chemotherapy regimen using Isoniazid $(H)$, Rifampin $(R)$, Pyrazinamide $(Z)$, and Ethambutol $(E)$.

MDR TB

Multi-Drug Resistant Tuberculosis, defined by bacteria being resistant to both Isoniazid and Rifampin.

Immune Reconstitution Inflammatory Syndrome (IRIS)

A worsening of abscesses caused by a rebound immune response seen on MRI $2\text{--}3$ months after starting therapy.

Toppling

A spine-at-risk sign signifying spinal instability and a tendency for collapse, mandating immediate surgical intervention.