UMEM Educational Pearls

Title: Spinal Deformity

Keywords: spinal, international, tuberculosis, scoliosis, kyphosis, pulmonary, neurologic (PubMed Search)

Posted: 1/9/2013 by Andrea Tenner, MD
Click here to contact Andrea Tenner, MD

Question

These two Ethiopian boys present with “back problems”. What are the diagnoses and what do you need to worry about with each of them?

Answer

The boy on the left has spinal tuberculosis (Pott's Disease) while the one on the right has severe scoliosis.

Pott's Disease:

Kyphosis caused by anterior vertebral body "wedging", usually in the thoracic spine
Most commonly causes motor deficits (usually leg weakness) and pain
Patients generally do not need respiratory isolation unless concurrent pulmonary TB is suspected.
Diagnosis: imaging, surgical biopsy and culture
Treatment: decompressive surgery for neurologic deficits and anti-TB chemotherapy

Severe Scoliosis:

Caused by lateral displacement and rotation of inact vertebral bodies (thus can lead to kyphoscoliosis)
Can cause severe respiratory impairment through decreased chest wall compliance, decreased lung compliance (due to progressive atelectaisis), and pulmonary hypertension
Diagnosis: clinical, imaging
Treatment: Pulmonary dysfucntion, once it occurs, is considered irreversible. Surgery may prevent further worsening.

Bottom Line:

Spinal tuberculosis most commonly causes anterioposterior (AP) deformity and can cause severe neurologic deficits. Anti-TB medication is needed for treatment.

Severe scoliosis involves lateral as well as AP deformity and can cause severe pulmonary dysfunction.

University of Maryland Section of Global Emergency Health

Author: Andi Tenner, MD, MPH

References

Center for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacerium tuberculosis in Health-Care Settings. MMWR 2005;54(No. RR-17):1-144.

Koumbourlis AC. Scoliosis and the respiratory System. Paediatric Respiratory Reviews 2006;7:152-160.

Turgut M. Spinal tuberculosis (Pott’s disease): its clinical presentation, surgical management, and outcome. A survey study on 694 patients. Neurosurg Rev 2001;24:8-13.

Attachments

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