1.What are the systemic symptoms of spinal tuberculosis? Answer: The systemic symptoms of spinal tuberculosis are mainly symptoms of tuberculosis poisoning, which are generally characterized by low fever (especially in the afternoon), night sweats (night sweats are obvious), fatigue, poor diet, loss of appetite, poor sleep and other symptoms, and may be accompanied by weight loss. There are also patients whose systemic symptoms are caused by local symptoms, such as spinal tuberculosis combined with paraplegia, double lower limb mobility disorders will cause decreased appetite, which will lead to electrolyte disorders, causing abdominal distension and other symptoms. In some cases, spinal tuberculosis lesions irritate the nerve roots, causing radicular pain, which leads to intolerable pain and affects the patient’s spirit, appetite and sleep. This type of patients is very common in clinical practice. 2.Does spinal tuberculosis cause pain? What are the locations where pain usually occurs? Answer: Tuberculosis of the spine usually causes pain in the posterior part of the spine, which is caused by the stimulation of the periosteum full of nerves by pus, granulation and dead bone produced by bone destruction, and severe radicular pain will be produced when the nerve roots issued from the vertebral canal are stimulated by the lesions, which is difficult to be controlled by pain-relieving drugs. Generally, the location of spinal tuberculosis pain corresponds to the location of the lesion, such as thoracic tuberculosis pain is in the posterior thoracic spine, lumbar tuberculosis pain is in the posterior lumbar spine, and sacral tuberculosis is in the sacral spine, etc. However, if the spinal tuberculosis produces necrosis, the pain will be severe. However, if the necrotic material produced by spinal tuberculosis irritates the nerve roots, then radiating pain is produced, and then the location of the pain may not only be at the location of the spinal lesion. For example, tuberculosis of the thoracic spine may stimulate the intercostal nerves and cause radiating pain, sometimes radiating to the right quarter of the ribcage, which is misdiagnosed as “gallstones” or “cholecystitis”, etc. Tuberculosis of the cervical spine may cause radiating pain in the upper limbs, which is misdiagnosed as “cervical spondylosis”. Cervical spine tuberculosis sometimes causes radiating pain in the upper limbs, which is misdiagnosed as “cervical spondylosis”, and lumbar spine tuberculosis sometimes causes pain and radiating pain in the lower limbs, which is misdiagnosed as “lumbar intervertebral disc herniation”. 3.If I have spinal tuberculosis, what is the impact on my life? How to detect it? A: If you have spinal tuberculosis, it will have a serious impact on your life. Spine due to the roof of the load-bearing large number, once damaged, it is very likely to cause instability of the spine, the good thing is that spinal tuberculosis occurs in the front of the spine, the beginning of the image of stability is not big, but such as continue to progress, will cause the destruction of the entire vertebrae and their attachments, and even compression of the spinal cord, resulting in paralysis, and some of the spinal tuberculosis abscesses will penetrate the skin to form a fistula, penetrate organs or blood vessels, the formation of the corresponding Complications. In this kind of patients, although the infectiousness is not strong, but the individual damage to the patient is large, and the rate of disability and deformity is high. The diagnosis of typical spinal tuberculosis is relatively easy, generally through X-ray, CT or MRI methods, combined with clinical symptoms and signs can be diagnosed, but this diagnosis is a clinical diagnosis. The final diagnosis of spinal tuberculosis should be bacteriologic, but unfortunately it is very difficult to obtain bacteriologic diagnosis in patients with spinal tuberculosis. In some cases, a pathologic or bacteriologic diagnosis can be made by CT-guided puncture prior to surgery, but most physicians are either reluctant to perform this risky puncture or are unwilling to do so. However, most doctors are reluctant to perform this risky puncture, except for those patients who are really difficult to diagnose. 4.What is the “night cry” in children with spinal tuberculosis? A: Children with spinal tuberculosis usually do not have “night crying” unless the spinal tuberculosis has caused spinal instability or the lesion has irritated the nerve roots. Children with joint tuberculosis are prone to the phenomenon of “night crying”, which is mainly due to the relaxation of the protective mechanism of the joints and their surrounding ligaments at night after sleep, resulting in friction of the damaged bony joint surfaces and causing pain. 5.What kind of deformity will appear in spinal tuberculosis? The deformity that often occurs in spinal tuberculosis is “posterior protrusion deformity” of the spine. The spine is divided into anterior, middle and posterior columns according to its anatomical stability, which is widely accepted as the “three columns” theory of the spine. Tuberculosis of the spine occurs in the anterior column, where the destruction of the bone quality and the low supportive force cause instability and collapse of the anterior column, which, together with the influence of gravity and the continued destruction of tuberculosis, results in the formation of a kyphotic deformity. Posterior protrusion deformity is an important sign for diagnosing spinal tuberculosis, and spinal tumors and other diseases usually do not form posterior protrusion deformity. 6.What are the characteristics of abscess in spinal tuberculosis? In which parts of the body can they be found? A: Cold abscesses caused by spinal tuberculosis can appear in the anterior, lateral or posterior part of the vertebral body in the early stage. It usually appears in a position corresponding to the diseased vertebra. Cold abscess corresponding to the anterior spine can be diagnosed by CT. Cold abscess corresponding to the soft tissues of the spine, which is more obvious, can be lighter by naked eye and hand touch, and most of them can be detected by ultrasound to find out its depth, size and direction of the flow of abscess, etc. However, with the development of the disease, cold abscess can be diagnosed in the early stage. However, with the development of the disease, the abscess is expanding, such as tuberculous destruction in the cervical spine, the abscess can be directly protruding into the esophagus behind the esophagus, compression of the esophagus caused by the difficulty of eating and swallowing, due to the role of the center of gravity force, the abscess can be extended downward for the pouch cylinder changes. In the cold abscess of cervicothoracic spine, the pus may sag along the cervical longissimus muscle and flow into both sides of the upper mediastinum, and sometimes the shadow of the mediastinum appears to be enlarged on the X-ray, and there is a possibility of misdiagnosis as a tumor. After the formation of cold abscess in thoracolumbar spine, the thoracic and abdominal cavities are easy to spread the paravertebral abscess due to physiological curvature or pressure, so that the periosteum and anterior longitudinal ligament which are easy to be lifted up increase with the gradual spherical shape of pus to the point of slippery extension changing its shape and position. Tuberculous lesions of the lumbar spine are not susceptible to the formation of paravertebral cold abscesses. Because of the physiologic anterior protrusion of the lumbar spine, the pus can flow along the psoas major muscle with gravity to the lower abdomen near the deltoid muscle or the lesser trochanter. It can also flow along the psoas major muscle through the bursa of the iliopsoas muscle, forming a cold abscess under the gluteus maximus muscle. Tuberculosis of the lumbosacral spine can flow to form a lumbar major or presacral abscess. It can perforate the sigmoid colon and thus form an internal fistula or, in a few cases, an external fistula.