Tuberculosis del Sistema Esquelético (Huesos, Articulaciones, Columna y Vainas Bursales

Section 1: General Considerations
1. Epidemiology and Prevalence 3
Regional Distribution 5
Incidence of Disease and Institutional Data 7
Prophylaxis against Tuberculosis and BCG Vaccination 8
2. Pathology and Pathogenesis 10
Experimental Tuberculosis 10
Osteoarticular Disease 11
Spinal Disease 12
Role of Trauma 12
The Tubercle 13
Cold Abscess 14
Tubercular Sequestra 14
Spinal tuberculosis 16
Types of the Disease 16
Future Course of the Tubercle 17
Tuberculosis as a Late Complication of “Implant-Surgery” 17
Immunopathology of Skeletal Tuberculosis 18
Therapeutically Refractory Cases 19
Immunodeficient Stage and Looming Tuberculosis Epidemic 19
Immunomodulation 22
3. The Organism and its Sensitivity 24
Mycobacterium tuberculosis 24
Mycobacterium Cultures 25
Sensitivity of Organism 26
Disease Caused by Atypical Mycobacteria 27
4. Evolution of Treatment of Skeletal Tuberculosis 28
Preantitubercular era 28
Postantitubercular Era 31
5. Diagnosis and Investigations 36
General Clinical Picture 36
Diagnosis 36
6. Antitubercular Drugs 50
Streptomycin 50
Para-aminosalicylic Acid 51
Isoniazid 51
Contents
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Tuberculosis of the Skeletal System
Ethambutol 52
Rifampicin 52
Pyrazinamide 55
Thioacetazone with other Drugs 55
Alternative Regimens 55
Corticosteroids and Nonsteroidal Anti-inflammatory Drugs 56
The Role of Antitubercular Drugs 57
Penetration of Antitubercular Drugs 58
7. Principles of Management of Osteoarticular Tuberculosis 61
Prognosis and Course 61
Classification of Articular Tuberculosis 61
Principles of Management 65
Section 2: Extra-spinal Regional Tuberculosis
8. Tuberculosis of the Hip Joint 75
Clinical Features 75
Prognosis 89
Management 91
Indications for Surgical Treatment 100
Surgical Approaches to the Hip Joint 102
Alternative Approaches 108
Relevant Surgical Anatomy of the Hip Joint 118
9. Tuberculosis of the Knee Joint 121
Pathology 121
Clinical Features 122
Differential Diagnosis 125
Prognosis 127
Treatment 127
Surgical Techniques 131
Relevant Surgical Anatomy of the Knee Joint 137
10. Tuberculosis of the Ankle and Foot 140
Tuberculosis of Ankle 140
Tuberculosis of Foot 144
Relevant Surgical Anatomy of the Ankle and Foot 147
11. Tuberculosis of the Shoulder 149
Management 150
Arthrodesis of Shoulder 154
Relevant Surgical Anatomy of the Shoulder Joint 156
12. Tuberculosis of the Elbow Joint 158
Management 160
Operative Techniques for Tuberculous Elbow 161
Relevant Surgical Anatomy of Elbow Joint 165
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Contents
13. Tuberculosis of the Wrist 167
Clinical Features 167
Management 170
Operative Treatment 170
Wrist Arthrodesis 170
Relevant Surgical Anatomy of the wrist 171
14. Tuberculosis of Short Tubular Bones 173
Differential Diagnosis 173
Tuberculosis of the Joints of Fingers and Toes 174
15. Tuberculosis of the Sacroiliac Joints and Sacrum 176
Clinical Features 176
Management 177
16. Tuberculosis of Rare Sites, Girdle and Flat Bones 181
Sternoclavicular Joint 181
Acromioclavicular Joint 181
Tuberculosis of Clavicle 181
Tuberculosis of Scapula 182
Tuberculosis of Symphysis Pubis 183
Tuberculosis of Skull and Fascial Bones 187
Tuberculosis of Sternum and Ribs 189
17. Tuberculous Osteomyelitis 190
Tuberculous Osteomyelitis without Joint Involvement 190
Tuberculosis of Long Tubular Bones 191
Treatment 197
18. Tuberculosis of Tendon Sheaths and Bursae 198
Tuberculous Bursitis 200
Section 3: Tuberculosis of the Spine
19. Clinical Features 203
Age and Sex 205
Symptoms and Signs 206
Abscesses and Sinuses 207
Analysis of Clinical Material 208
Regional Distribution of Tuberculous Lesions
in the Vertebral Column (In the Pre-MRI Era—Observed by
Conventional X-rays) 208
Vertebral Lesion 210
Associated Extra-spinal Tubercular Lesions 210
20. X-ray Appearances and Findings on Modern Imaging 212
Number of Vertebrae involved 212
Kyphotic Deformity (Angulation of Spine with Convexity
Posteriorly) 220
Central Type of Lesion (Tuberculosis of the Centrum) 222
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Tuberculosis of the Skeletal System
Lateral Shift and Scoliosis 227
Natural Course of the Disease 228
Modern Imaging Techniques 230
21. Differential Diagnosis 239
Clinico-radiological Classification of Typical
Tubercular-Spondylitis 236
Consideration of Age in Diagnosis 239
Pyogenic Infections 240
22. Neurological Complications 252
Incidence 252
Classification of Tuberculous Paraplegia 254
Pathology of Tuberculous Paraplegia 256
Extradural Granuloma and Tuberculoma 258
Signs and Symptoms of Pott’s Paraplegia associated with
Disease Proximal to Lumbar First Vertebra 262
Myelography (Now Replaced by mrIs) 263
Prognosis for Recovery of Cord Function 266
Treatment of Pott’s Paraplegia 268
23. Management and Results 271
Evolution of Treatment 271
24. Operative Treatment 315
Cold Abscesses 315
Surgical Approaches 316
Operative Procedures 319
Operative Complications and their Prevention 337
Anterolateral Approach to the Lumbar Spine
(Lumbovertebrotomy) 339
Surgery in Severe Kyphosis 348
Instrumentation in Tuberculous Spine 353
Re-operation for Decompression 354
25. Spinal Braces 358
26. Relevant Surgical Anatomy 362
Vertebral Bodies 362
Intervertebral Joint 363
Intervertebral Disc 364
Blood Supply of the Vertebral Column 365
The Bony Vertebral Canal 366
Blood Supply to the Spinal Cord 366
Cross-sectional Topography of the Spinal Cord 368
Take Home Key Points (Collated by Dr Apurv Mehra) 369
Bibliography 387
Section I and II: General Considerations and
Extra-spinal Regional Tuberculosis 387
Section III: Tuberculosis of the Spine 408
Index 425