Pathophysiology

Tuberculous Osteitis = Osteomyelitis + infective arthritis 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.

Cough > 2 weeks, weight loss, pulmonary ssx, night chills Localized back pain Kyphosis Paraplegia, loss of sphincter tone, nerve root pain; inguinal pain Extra-spinal infection (Lungs) Hematogeneous spread Progressive bone destruction of > 2 Vertebral body (anterior part adjacent to subchondral plate in the thoracolumbar junction) Spread to intervertebral DISCs Caseation necrosis Vertebral narrowing (abscess, granulation tissue, or direct dural invasion) Collapse of anterior part of vertebrae (avascular) Kyphosis (Thoracic > Lumbar) Formation of soft tissue mass (gibbus formation) Spinal damage (Spinal cord compression) and neurological signs (Pott’s paralysis) Psoas abscess

Psoas Abscess Comes from tuberculous abscess of the lumbar vertebrae that tracks from the spine towards the sheath of the psoas muscle SSX –Tender swelling below the inguinal ligament –Apyrexial –Similar appearance with femoral hernia or enlarged inguinal lymph nodes