1. How does spinal tuberculosis develop? Tuberculosis of the spine is a very common infectious disease. It occurs in children and adolescents and has a very high disability rate, which seriously affects the health of adolescents. It is a secondary tuberculosis with a primary lesion of pulmonary or gastrointestinal tuberculosis, and the pathogenic bacteria are mostly Mycobacterium tuberculosis. More than 50% of patients with pulmonary tuberculosis have a combination of bone and joint tuberculosis. The incidence of spinal tuberculosis accounts for about 48% of bone and joint tuberculosis. The most common sites of incidence are the lumbar spine, cervical spine, thoracic spine, thoracolumbar spine, lumbar spine and lumbosacral spine. 2. What is the risk of spinal tuberculosis to the human body? Tuberculosis of the spine is the most dangerous type of bone and joint system, which can lead to bone destruction, deformity and paralysis. In the process of treatment, various non-standard treatment methods can lead to undesirable misdiagnosis, omission, postoperative abscess and sinus tract formation, non-healing of surgical incisions, leading to deterioration, recurrence, and paraplegia. In severe cases, the spread of tuberculosis leads to tuberculous meningitis, which can result in the death of the patient. Instead of solving the patient’s pain, this will increase their pain and financial burden. 3.What are the clinical manifestations and signs of spinal tuberculosis? (1) Systemic symptoms patients often have symptoms of general malaise, fatigue, loss of appetite, body wasting, low fever in the afternoon, mild toxic symptoms such as hot flashes and night sweats, and symptoms of plant nerve dysfunction. If mixed infection occurs in abscesses, high fever can occur. Fever is more common in children, who do not like to play, cry and scream at night. In case of combined tuberculosis, cough, sputum, hemoptysis or dyspnea may occur. (2) Pain Pain symptoms often appear early, and the degree is proportional to the degree of the lesion, increasing after walking and exertion and decreasing after rest. Pain can be classified as localized or radiating. Localized pain is usually found on both sides of the spinous process of the affected vertebrae or between the spinous process and spine, and the site of pain is often the site of spinal involvement. When the lesion affects the nerve roots, radiating pain may occur in the area of innervation of the corresponding nerve segment. The site of pain is sometimes inconsistent with the lesion, and patients with thoracolumbar lesions often complain of pain in the lumbosacral region. If the lesion compresses the spinal cord and nerve roots, the pain may be quite intense and radiates along the nerve roots. Because the vertebral body is far from the spinous process, the local pressure pain is less obvious: percussion on the local spinous process can cause pain. (3) Postural abnormalities vary in the posture adopted by the patient because of different lesion sites. Patients with cervical spine tuberculosis often have oblique neck deformity. Patients with tuberculosis of the thoracolumbar, lumbar and lumbosacral spine try to tilt their head and trunk back when standing or walking, and prefer to hold the chair with their hands when sitting in order to reduce the pressure of their weight on the affected vertebrae. Patients with lumbar spine tuberculosis try to pick up things from the ground by bending the knees, bending the hips, avoiding bending, and using their hands to hold the front of the thighs when standing up, known as a positive pick-up test. (4) Spinal deformity kyphosis is more common. Posterior convexity deformity is common in thoracic spine tuberculosis, mostly angular convexity, and lateral convexity is uncommon and not serious. Because the normal physiological curve of the cervical and lumbar segments bends forward, the kyphosis is not obvious after destruction of the vertebral body, but the kyphosis of the thoracic segment is more obvious because of the overlap of physiological kyphosis and pathological kyphosis. Pediatric thoracic spinal tuberculosis has a high number of involved vertebral bodies and is therefore very prone to develop a retroconvex deformity. (5) Muscle spasm starts as reflex spasm of the paravertebral muscles of the spine caused by pain, which then turns into spastic muscle tension and causes some abnormal postures, i.e. forced postures. The forced posture varies in different areas, such as the sloping neck in patients with cervical TB and the haughty gait in patients with thoracolumbar TB. In children and young adults, “rigidity” and scoliosis can be seen. After children go to sleep at night, restriction of spinal movement causes spasms and relaxation of the muscles of the spine in a specific painless position, causing pain when turning over or changing position, resulting in sudden pain in children and causing “nocturnal crying in children” is more common. (6) Restriction of spinal movement due to protective spasm of the muscles around the lesion, and restriction of movement of the affected spine, which is easily detected in the cervical and lumbar spine where the range of motion is large, but not in the thoracic spine where the mobility is small. (7) Cold abscess is often one of the signs that patients present to the clinic, and sometimes the abscess is mistaken for a tumor. In upper cervical spine tuberculosis, abscesses form in the posterior pharyngeal wall and may flow downward on both sides into the posterior cervical triangle and downward into the posterior mediastinum. Pus from lower thoracic spine tuberculosis often forms abscesses of the psoas major muscle, which may even extend to the surface of the chest and appear on the anterior chest wall. Lumbar spine tuberculosis often forms abscesses of the lumbar muscle, which may flow downward to the iliac fossa or to the posterior aspect of the inguinal ligament, forming abscesses of the iliac fossa. (8) Neurological dysfunction is caused by direct compression of the spinal cord by the lesioned tissue of tuberculosis, which can cause neurological dysfunction, manifested as sensory and motor dysfunction of the extremities and urinary and fecal dysfunction. 4.What are the treatment methods of spinal tuberculosis? Drug chemotherapy is the main treatment, and other treatments, including surgical treatment, should be regarded as auxiliary methods. It is recommended to eat high-protein, high-calorie, vitamin-rich food. If the nutritional status is particularly poor, a small number of transfusions of fresh blood, amino acids, fatty milk and other highly nutritious fluids can be given to improve the body. Fatigue should be avoided as much as possible and proper rest should be given. Attention should be paid to braking, and those with poor general condition, high body temperature, paraplegia or unstable vertebrae should be strictly bed rested. The current standard chemotherapy regimen for bone and joint tuberculosis in China is a combination of isoniazid, rifampin, ethambutol, and streptomycin. After 3 months of intensive treatment, streptomycin is discontinued and isoniazid, rifampin and ethambutol are continued for 6 to 15 months, with a total duration of 9 to 18 months. Specific doses and methods: isoniazid 300mg, rifampin 450mg, ethambutol 750mg, daily (all taken in the morning on an empty stomach), streptomycin 0.75g, intramuscular injection, once a day (applied in the first 3 months of the course). 5.What are the cases of spinal tuberculosis that require surgical treatment? (1) negative closed puncture biopsy with clear pathological diagnosis; (2) spinal cord compression causing neurological signs; (3) obvious deformity or severe destruction of vertebral body; (4) mixed infection with poor conservative treatment; (5) persistent pain or persistent high blood sedimentation; (6) sinus tract formation and combined infection.