Tb of lumbar spine Flashcards
what is tuberculosis of spine?
- Also known as pott disease or decay spine
* tubercular infection of the vertebrae by m. tuberculosis
what is the most common site in tb of spine?
vertebrae
percentage seen cases in tb of spine?
50%
which vertebrae affect most in tb spine?
lower dorsal and lumbar spine
why?
due to cancellous nature of bones and body weight transmission through these areas.
who is most common affected?
children
age group?
5 to 10 years
pathophysiology?
the bacteria reach —spine—via the haemotogenous route—from lung or lymph nodes—spread via the paravertebral plexus of veins (batson plexus) —which communicate freely with the visceral
plexus of the abdomen
clinical features
pain and rigidity in the back(localised affected area)
may radiate along the spinal nerves
pain from a lesion in the dorsal spine may radiate to the front of the chest and its called girldle pain
•presences of abcess
(associates with the pain in the back or be the presenting symptoms)
•the pus may trickle down, from the vertebrae along the course of a nerve or vessel and present over the chest wall or back or maybe seen on xray as a paravertebral shadow
•becoz this abscess is generally away from the site of activity i.e the site of the disease it does not have redness or raised local temperature and hence its called cold abscess
•other features:
low grade fever
cough
loss of appetite
weight loss
when the disease advance- compression of cord due to pus may result in paraplegia
on examination
marked tenderness-spinous process of the involved vertebrae
•protective spasm may present in the muscle group close to the site in order to provide natural immobilisation
•attempts flexion of spine produce increase in pain
•kyphosis-collapse of vertebrae produce deformity
investigation
xray
ct
mri
biopsy
complications
abscess formation
paraplegia
pt management (for patients treated conservative)
during initial periods- prevent complications
pt. education- pt. should be educated on the postural attitude which may further compress the cord with subsequent complications
•gentle full rom active movement-cervical spine ,upper & lower extremity
•spinal immobilisation- reduce the efficiency of the respiratory system & therefore slow & deep breathing is valuable in maintaining the vital capacity
•proper positioning of the body
•strength of the muscle , innervated by the spinal segment of the affected vertebrae,should be checked often & exercises
after healing of the lesion mgt.
•gradually,progressive exercise are begun to mobilise
•strengthening the spine
•isometric of the spinal flexors rotator and side flexors can be initiated
•costal, diaphragmatic as well as apical breathing exercise- improve mobility of the thoracic spine
•begin spinal exercise with extension-gradually progressing to hypertension in prone position
mobility & strengthening of side flexion, rotation & flexion should be initiated in stages
•mobility should be progressed further as small active, free trunk
movement
•sitting up, standing and ambulation to be initiated with spinal brace
•preventive measures to avoid recurrence need to be explained & the use of spinal brace to be continued while working
pt mgt
pt treated by surgery
preoperative mgt
- chest physiotherapy
- positioning & movements to avoid immediate postsurgical complications such as thrombosis
- methodology of safe bed activities such as turning and transfers with a corset or a pop jacket
- technique of sitting from lying,getting down from bed,standing balance and ambulation
- mobility & strengthening exercises to the spine
- correct principle of ergonomic to be strictly observed postoperatively and in future
immediate postoperative phase
•the surgical procedure involves resection of the ribs,transverse process and sometimes even the affected vertebrae with decompression of the spinal cord.the pt. is nursed in bes; therefor care should be taken to avoid stresses over the operated area.
•chest physiotherapy in the form of deep breathing ex & diaphragmatic breathing- to avoid chest complications
(rib resection make breathing difficult and painful) it needs to be carefully done by the pt supporting the rib cage with both handa
•thrombosis is prevented by early strong movement of the ankle and toes.
•in the presence of paraplegia,passive movement & positioning of the body and lower extremities are important
•susceptible pressure points should be carefully inspected and protected
•simple resistive movement-arm
•avoid overhead stretching (as this put extra strain on the spine)
•SLR & pelvic rolling(contraindicated)
•functional exercise
