Primary Diagnosis

Tuberculous osteomyelitis (spondylitis).

Secondary Diagnosis

N/A

Diagnosis Discussion

Tuberculous spondylitis or osteomyelitis (Potts disease) is usually secondary to an extraspinal source of infection. Usually, more than one vertebra is involved. The area usually affected is the anterior aspect of the vertebral body adjacent to the subchondral plate. Tuberculosis may spread from that area to adjacent intervertebral disks. In adults, disk disease is secondary to the spread of infection from the vertebral body. In children, because the disk is vascularized, it can be a primary site. Progressive bone destruction leads to vertebral collapse and kyphosis. The spinal canal can be narrowed by abscesses, granulation tissue, or direct dural invasion. This leads to spinal cord compression and neurologic deficits. Kyphotic deformity occurs as a consequence of collapse in the anterior spine. Lesions in the thoracic spine have a greater tendency for kyphosis than those in the lumbar spine. A cold abscess can occur if the infection extends to adjacent ligaments and soft tissues. Abscesses in the lumbar region may descend down the sheath of the psoas, and the abscesses are typically calcified. In this case, there is a calcified paraspinal mass (abscess) with epicenter at the destroyed endplate extending into the paraspinal region, the psoas musculature and epidural space. It is not uncommon for the patient to exhibit minimal constitutional symptoms.

General Anatomic Area:

Lumbar

Secondary Anatomic Area:

N/A

Disease Category:

Infectious

Contributor:

AE Flanders, MD

Date:

10/01/2004

Difficulty Level:

Easy

Pathology Confirmed?:

Yes
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ACR Category Number:

N/A

Keywords:

infectious spondylitis, cold abscess, TB, Potts disease