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alliedacademies
September 20-21, 2017 | Philadelphia, USA
Global summit on
TUBERCULOSIS AND LUNG DISEASE
Int J Respir Med 2017 Volume 2 Issue 2
The physiopathology of tuberculosis has several phases,
initially by infection, with activation of T CD4+ CD8+
specific for tuberculous antibodies, followed by an activation
and enhancement of macrophages from INF-gamma, IL-2
and TNF-alpha that originate from a tuberculous granuloma,
formed in the core by macrophages and from the infectious
tissue that is easily aspirated or drained. Subsequently,
the macrophages that form the granuloma wall (Giant
Cells of Langerhans) are bound to death and together with
the necrotic fluid tissue within the granuloma form an
amorphous mass, and begins the caseosophageal phase,
which has adherent properties on the adjacent tissues and
more difficult to remove surgically, following the activation
of fibroblasts around the casein granulomatous mass with
collagen production and fibrotic tissue. These phases with
their timing (between 2 and 4 weeks) are well-known
and identifiable at the pulmonary level, less in bone and
vertebral bone. Spongy bone tissue for trabecular anatomy
allows a rapid evolution of the Colliquin process. The
cortical component of the vertebral body, more rigid and
compact, facilitates the blocking phase of Langerhans cell
granuloma. When the infection also involves the vertebral
walls, the vertebral collapse causes skeletal instability, and
aggravation of the pain. At this point there is the evolution of
infection from the next phase, caseosa. Magnetic resonance,
especially if with contrast medium, is a valid examination
that can detect the infected tissue but does not have any
valid information about tissue texture and metabolic activity.
A useful diagnostic evaluation is TC-PET that can provide us
with information about the metabolic activity of the affected
tissue, allowing to interpret the physiopathological phase.
The timing of tuberculous pathophysiology of vertebral
bone tissue should be considered of primary importance,
as well as the risk of fracture and nervous involvement in
the choice of the surgical solution. Specifically, a combined
approach (abscess drainage and possibly bone grafting) and
back (stabilization with peduncle screws) in a patient with
vertebral collapse and nerve involvement is considered
useful within the first weeks of the onset of the disease
when the colliquin phase is still present; in these patients
that have spent more time and already evolved the caseosa-
fibrotic phase infection, a single back approach (peduncle
stabilization open or minimally invasive and channel
decompression) is preferable.
Speaker Biography
Stefano Rigotti is a Medical Specialist in Orthopedics and Traumatology, Spine Surgery
in Dolomiti Sport Clinic.
e:
Timing of Pott’s disease for proper surgical treatment: Traditional open surgery andminimally invasive,
anterior and posterior approach
Stefano Rigotti and C Zorzi
Ospedale Sacro Cuore Don Calabria, Italy