Tuberculosis of the spine
Spinal tuberculosis, a member of the bone tuberculosis disease family, has a high incidence and is the first of the systemic bone and joint tuberculosis. Patients often suffer from loss of appetite, emaciation, anemia or hypoproteinemia, and should be actively supplemented with tasty, easily digestible, nutritious food. Lumbar spine tuberculosis is the most common form of spinal tuberculosis.
Lumbar spine tuberculosis is mostly seen in adults, and the lesions are confined to the upper and lower edges of the vertebral body and soon invade the intervertebral disc and adjacent vertebral bodies. Disruption of the intervertebral discs is characteristic of the disease, resulting in a narrow vertebral space.
Most lumbar spine tuberculosis is caused by pulmonary tuberculosis, and the tubercle bacilli are transmitted to the bone tissue with the blood stream. A few tubercle bacilli evade anti-tuberculosis drugs and hide in the body, colonizing the infection when the body’s immunity decreases, causing bone destruction to develop into bone tuberculosis.
The vertebral body of the spine is dominated by cancellous bone, and its trophoblastic artery is the terminal artery, where the venous blood flows slowly, and the tuberculosis bacilli can easily stay in the vertebral body.
I. Clinical manifestations
Local symptoms: pain
Low back pain is the most common symptom of lumbar spinal tuberculosis. Dull pain in the affected area and systemic symptoms such as hypothermia are often present at the same time, accompanied by pressure pain and percussion pain, aggravated by activities, coughing and sneezing, and alleviated after bed rest; the pain is aggravated at night.
The pain may radiate along the spinal nerve and the thoracic spine along the intercostal nerve to the abdomen, and is often misdiagnosed as cholecystitis, pancreatitis, appendicitis, etc. Lumbar spine lesions along the lumbar plexus mostly radiate to the front of the thigh, occasionally involving the back of the leg, and are easily misdiagnosed as intervertebral disc prolapse.
The pain is more pronounced when the patient changes position, especially at night when sleeping and losing the protection of muscle spasm.
Postural abnormalities
This is caused by spasm of the paravertebral muscles due to pain. Patients with cervical TB often have a sloping neck, forward head tilt, shortened neck and hands on the jaw. The posture of thoracic protrusion is common in the thoracolumbar or lumbosacral spine structures.
Normal people can bend over to pick up things, but because of the disease can not bend over but bend the hip and knee, one hand holding the knee and the other hand to pick up things on the ground, called a positive pick-up test.
Spinal deformity
The cervical and lumbar vertebrae are noted for loss of physiological anterior protrusion, and the thoracic vertebrae are noted for increased physiological posterior protrusion. From top to bottom, look for abnormal protrusion of each spinous process, especially limited angular protrusion, which is mostly seen in spinal tuberculosis, and is different from the arcuate protrusion and round back in young vertebral epiphyseal chondromalacia, ankylosing spondylitis, and poor posture.
In patients without proper treatment, there is spinal cord compression and partial or complete paraplegia in the late stages, which is a serious comorbidity that endangers the patient.
Cold abscess
At the time of consultation, 70% to 80% of spinal tuberculosis is complicated by cold abscesses, and paravertebral abscesses located deep in the spine can be revealed by X-ray radiography CT or MRI.
Systemic symptoms
The disease starts gradually and the date of onset is not clear. Patients have generalized toxic symptoms such as lethargy and weakness, loss of appetite, low fever in the afternoon, night sweats and emaciation.
Occasionally, a small number of acute episodes of deterioration with a temperature of about 39°C are seen, and most of them are misdiagnosed as severe colds or other acute infections.
Imaging examination
Radiographs show mainly bone destruction and spinal space narrowing. It can show irregular bone destruction, narrowing or disappearance of the vertebral space, collapse of the vertebral body, cavity, dead bone and cold abscess shadow and other signs.
CT examination can clearly show the site of the lesion, with or without cavity and dead bone formation. Even small paravertebral abscesses can be detected when examined on CT.
MRI has early diagnostic value and can show abnormal signals at the stage of inflammatory infiltration, but it is mainly used to observe whether there is compression and degeneration of the spinal cord.
Lumbar spine tuberculosis is not a simple inflammation, it is a lesion formed by the tuberculosis bacillus eroding the lumbar spine. If you have the above symptoms, seek early medical attention to avoid delaying the disease.