OVERVIEW
OVERVIEW
Vertebral tuberculosis is a lesion of the vertebral body caused by infection with Mycobacterium tuberculosis. Vertebral tuberculosis accounts for 98% of spinal tuberculosis and has the highest incidence in the thoracic and lumbar spine, which is related to the fact that there is little muscle attachment to the vertebrae, the thoracic and lumbar spine is heavily loaded and prone to injury, and there is a lot of cancellous bone, which is mostly terminally vascularized.
Whether medical insurance
Yes, it is
Department
Infectious diseases, orthopedics
Clinical symptoms
Pain, postural abnormalities, spinal deformity, limited spinal mobility, etc.
Hazards
Can lead to pneumonia, paraplegia, and life-threatening.
Examination
X-ray film, CT, MRI, blood sedimentation, tuberculin test, tuberculosis culture, tuberculosis PCR test, pathology examination, etc.
Diagnosis
Diagnosis is based on medical history, pain, postural abnormality, spinal deformity and other manifestations, combined with X-ray film, tuberculin test, tuberculin PCR test, and pathologic examination.
Treatment principle
Eradicate the infection completely, restore nerve function, and prevent spinal deformity.
Curability
Symptoms can be improved with active treatment.
Dietary recommendations
Give high-calorie, high-protein, high-vitamin diet, eat more vegetables and fruits, and avoid spicy and irritating food.
Etiology
Epidemiology
The disease is prevalent in children and adolescents, with peak incidence in the 20s and 30s, and slightly more in women.
Etiology
The disease is mostly secondary to tuberculosis lesions in other parts of the body.
Symptoms and Diagnosis
Typical symptoms
1. The pain is mostly mild and dull, aggravated by exertion, coughing and sneezing, and not obvious at night. With the long course of the disease, the pain becomes heavier and heavier.2. Postural abnormality is often manifested as oblique neck deformity, and patients with tuberculosis of thoracolumbar, lumbar and lumbosacral vertebrae try to tilt their heads and trunks back when they stand or walk, and like to use their hands to support the chair when they sit. They do not dare to bend over and flex laterally. When patients with lumbar spine tuberculosis pick up objects, they bend their knees and hips instead of bending their backs, and when they stand up, they hold the front of their thighs with one hand.3. Spinal deformity and limitation of activity: the most common deformity is posterior convex deformity, and the spinal activity is limited.4. Pressure and percussion pain: early lesions are deep and limited, and there is no pressure and pain, and local deformities appear, and then they may cause obvious pain.5. Cold abscesses are often the main signs of patients’ visits to the clinic.
Other symptoms
Symptoms of spinal cord and nerve root compression: some patients with spinal tuberculosis consult the doctor because of pain, numbness and weakness caused by irritation and compression of the spinal cord and nerve roots. On examination, there are somatic sensory and motor disorders. In the late stage, there may be spastic paralysis or flaccid paralysis and pathological reflexes.
Diagnostic basis
1. history of previous history of tuberculosis or history of exposure to tuberculosis.2. clinical manifestations mainly include pain, postural abnormality, spinal deformity, limitation of spinal movement, pressure pain, percussion pain, cold abscess, etc.3. auxiliary examination (1) X-ray examination: manifestation of bone destruction, deformation of vertebral body, spinal convexity, vertebral bodies embedded in each other, narrowing of vertebral interspace, increase or decrease of bone mineral density, formation of new bone or bridge of bone in abscess, and pathologic dislocation. (2) Tuberculin test: It is helpful for the early diagnosis of patients under 5 years old who have not received BCG vaccine; children over 5 years old are mostly positive, but strong positivity should also be emphasized. (3) Pathologic examination: It has a high diagnostic rate for this disease. (4) CT and MRI examination: For early lesions that do not show well on X-ray, CT or MRI can be used to detect the vertebral body or accessory foci and inflammation or abscess in the surrounding soft tissues at an early stage.
Treatment
Treatment guideline
Thoroughly eradicate the infection, restore nerve function and prevent spinal deformity. Use systemic and local treatment, give anti-tuberculosis drugs, and surgery if necessary.
Drug treatment
Anti-tuberculosis drugs such as isoniazid, rifampicin and p-toluic acid are given.
Surgical treatment
Posterior spinal implant fusion, anterior spinal implant fusion, lesion removal, etc.
Other treatments
Lie on a hard board bed and the spine is immobilized with a brace or plaster.
Prognosis
Prognosis can be improved with aggressive treatment.
Questions you may be concerned about
When is the most appropriate time to operate for bone destruction of thoracic vertebrae 10-11, vertebral tuberculosis with abscess?
In the case of thoracic vertebrae 10-11 vertebral body bone destruction, vertebral body tuberculosis with abscess, first need to carry out anti-tuberculosis treatment, and when the condition is stable and there is no contraindication to surgery, then surgical treatment can be carried out.
Bone destruction of vertebral body of thoracic vertebrae 10-11 may be caused by vertebral tuberculosis with abscess, and the primary focus of vertebral tuberculosis with abscess may come from the lungs, which is caused by the transfer of pulmonary tuberculosis to the concha.
Therefore, anti-tuberculosis treatment should be carried out first, and commonly used drugs include rifampicin, isoniazid, ethambutol, etc. Patients need to stabilize their condition before considering surgery.
When this situation occurs, it is recommended that the patient go to the hospital as soon as possible, under the guidance of the doctor to carry out standardized treatment, if you need to use medication, you should also be under the guidance of the doctor, to avoid unauthorized use of drugs.
Nursing care
Daily care
1. Keep the environment quiet and clean, with appropriate temperature and humidity. 2. Keep the mouth clean and dry to avoid infection. 3. Turn over regularly to reduce the occurrence of pressure ulcers. 4. Follow the doctor’s instructions for medication, and consult the doctor in time for any abnormalities.
Dietary management
Give high-calorie, high-protein, high-vitamin diet, eat more vegetables and fruits, avoid spicy and stimulating food.