Tuberculosis of the Skeletal System

S M TULI, Senior Consultant in Spinal Diseases and Orthopaedics, Vidyasagar Institute of Mental Health and Neurosciences, Nehru Nagar, New Delhi. With the resurgence of tuberculosis as a global phenomenon, and the prevalence of AIDS worldwide, skeletal tuberculosis is on the increase, both in the West and the developing countries. Now in it's fourth edition this reference book will appeal to orthopaedic surgeons at all levels. It provides a thorough description of the abnormalities of each of the major joints, covers diagnostic methods, treatment methods and surgical techniques. Contents: Section I GENERAL CONSIDERATIONS 1. Epidemiology and Prevalence ............................................................ 3 2. Pathology and Pathogenesis ............................................................... 9 3. The Organism and its Sensitivity .................................................... 21 4. Evolution of Treatment of Skeletal Tuberculosis ........................ 25 5. Diagnosis and Investigations ........................................................... 32 6. Antitubercular Drugs ......................................................................... 45 7. Principles of Management of Osteoarticular Tuberculosis........ 56 Section II EXTRA-SPINAL REGIONAL TUBERCULOSIS 8. Tuberculosis of the Hip Joint ........................................................... 69 9. Tuberculosis of the Knee Joint ...................................................... 111 10. Tuberculosis of the Ankle and Foot .............................................. 131 11. Tuberculosis of the Shoulder ......................................................... 140 12. Tuberculosis of the Elbow Joint .................................................... 149 13. Tuberculosis of the Wrist ................................................................ 158 14. Tuberculosis of Short Tubular Bones ........................................... 164 15. Tuberculosis of the Sacroiliac Joints ............................................ 167 16. Tuberculosis of Rare Sites, Girdle and Flat Bones .................... 172 17. Tuberculous Osteomyelitis ............................................................. 179 18. Tuberculosis of Tendon-Sheaths and Bursae ............................. 187 Section III TUBERCULOSIS OF THE SPINE 19. Clinical Features ............................................................................... 193 20. X-ray Appearances and Findings on Modern Imaging ............. 200 21. Differential Diagnosis ..................................................................... 227 22. Neurological Complications ........................................................... 239 23. Management and Results ................................................................ 259 24. Operative Treatment ........................................................................ 302 25. Spinal Braces ..................................................................................... 344 26. Relevant Surgical Anatomy ............................................................ 347 BIBLIOGRAPHY • General and Extra-spinal Disease.................................................. 355 • Spinal Tuberculosis.......................................................................... 371 Index ..................................................................................................... 385 Foreword to the Fourth Edition It is a privilege to write the foreword for the 4th edition of a book which carries the experience and wisdom of one of the most gifted clinician, a great teacher and a brilliant academicians of our times. Tuberculosis is an ancient disease but unfortunately is still not a disease of the past. By even a conservative estimate, there are more than 3 million people with active bone and joint tuberculosis in the world today. The problems of multi-drug resistance, co-infection with HIV along with increased global travel have unfortunately helped to increase the incidence of this disease worldwide. Compared to yesteryears, the clinical picture of the disease has changed a lot with many atypical forms and presentations of the disease. Similarly advances have occurred and new knowledge has been added in the fields of diagnosis, imaging studies, drug therapy and surgical techniques. There is no doubt that a textbook dedicated to osteo-articular tuberculosis providing safe guidelines in management is the need of the hour. The fourth edition of this already hugely popular book will thus fillin a timely need for a comprehensive and latest update on the changing profile of the disease and the advances that have occurred in the treatment of this disease. Prof Tuli has been involved in the management of this disease over the last 50 years and has authoritative experience. His proposal of ‘Middle path regime’ was one of the landmarks in the management of spinal tuberculosis. His professional experience has covered the various advances in tuberculosis management for the past many decades and the book, no doubt, will carry the best of wisdom from personal experience and also the summary of current trends. This edition is carefully structured to provide a complete coverage of all relevant knowledge on the subject. It includes all necessary details but is also sufficiently concise to provide easy readability. It contains material that is required both for the surgeons in training and for the practicing orthopedic surgeons and hence will find a useful place on the desk of one and all. I pray for the Almighty’s Grace that we have Prof Tuli to write many more editions of this wonderful monogram. S Rajasekaran MS FRCS MCh FACS PhD President, Association of Spine Surgeons of India Vice-President, International Society for the Study of Lumbar Spine Chairman, Department of Orthopedics and Spine Surgery Ganga Hospital, Coimbatore, India Foreword to the Fourth Edition It is a privilege to write the foreword for the 4th edition of a book which carries the experience and wisdom of one of the most gifted clinician, a great teacher and a brilliant academicians of our times. Tuberculosis is an ancient disease but unfortunately is still not a disease of the past. By even a conservative estimate, there are more than 3 million people with active bone and joint tuberculosis in the world today. The problems of multi-drug resistance, co-infection with HIV along with increased global travel have unfortunately helped to increase the incidence of this disease worldwide. Compared to yesteryears, the clinical picture of the disease has changed a lot with many atypical forms and presentations of the disease. Similarly advances have occurred and new knowledge has been added in the fields of diagnosis, imaging studies, drug therapy and surgical techniques. There is no doubt that a textbook dedicated to osteo-articular tuberculosis providing safe guidelines in management is the need of the hour. The fourth edition of this already hugely popular book will thus fillin a timely need for a comprehensive and latest update on the changing profile of the disease and the advances that have occurred in the treatment of this disease. Prof Tuli has been involved in the management of this disease over the last 50 years and has authoritative experience. His proposal of ‘Middle path regime’ was one of the landmarks in the management of spinal tuberculosis. His professional experience has covered the various advances in tuberculosis management for the past many decades and the book, no doubt, will carry the best of wisdom from personal experience and also the summary of current trends. This edition is carefully structured to provide a complete coverage of all relevant knowledge on the subject. It includes all necessary details but is also sufficiently concise to provide easy readability. It contains material that is required both for the surgeons in training and for the practicing orthopedic surgeons and hence will find a useful place on the desk of one and all. I pray for the Almighty’s Grace that we have Prof Tuli to write many more editions of this wonderful monogram. S Rajasekaran MS FRCS MCh FACS PhD President, Association of Spine Surgeons of India Vice-President, International Society for the Study of Lumbar Spine Chairman, Department of Orthopedics and Spine Surgery Ganga Hospital, Coimbatore, India