Tuberculous spondylitis - Pott disease - Treatment

Before the discovery antituberculostaticelor make efficient Pott's disease was treated with prolonged immobilization with bed rest.At that time it had a mortality of 20% and 30% relapse.Therapeutic indications have evolved. Studies show that Pott's disease is treated with tuberculostatics for 6-9 months. Isoniazid and rifampicin should be administered throughout therapy.Additional drugs are administered in the first two months. These include pyrazinamide, ethambutol and streptomycin. Using second-line drugs is indicated in case of resistance.
Indications for surgical therapy for Pott's disease include:-Neurological deficiency: acute neurological deterioration, paraparesis, paraplegiaSpinal instability, deformity and painLack of response to pharmacological therapy-Large paraspinal abscessNondiagnostic biopsy-samples.
Lozalizarea lesion expansion and destruction of this compression spinal cord or spinal deformity determine specific Interventional Approach. Vertebral destruction is considered significant when 50% of the vertebral body is collapsed or destroyed or there is a spinal deformity more than 5 degrees. The previous practice of focal debridement and stabilization with posterior instrumentation.If the disease is cervical spine surgery in point:High-frequency and severity of neurological deficitsSevere compression by abscess-inducing dysphagia or asphyxia-Instability of the cervical spine.Vertebral collapse of small magnitude is not considered an indication for surgery because it progresses to severe deformation.
Prognosis.Current treatment modalities are very effective if the disease was not complicated by severe deformity or stable neurological deficits.Compliance to therapy and drug resistance are additional factors that significantly affect the patient's evolution. Paraplegia by medullary compression determining active disease responds well to chemotherapy. If medical therapy does not cause a rapid improvement, interventional decompression increases the rate of recovery. Paraplegia can occur or persist during the healing spinal injuries due to permanent.