Lumbar spine tuberculosis The legendary “turtle back infection” is actually a common name for lumbar spine tuberculosis, a member of the bone tuberculosis disease family, which has a high incidence and is the first of the systemic bone and joint tuberculosis. Patients often have a loss of appetite, body wasting, anemia or hypoproteinemia, and should be actively supplemented with tasty, easily digestible, nutritious food. 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 discs and adjacent vertebral bodies. Intervertebral disc destruction 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, making it easy for the tuberculosis bacilli to stay in the vertebral area. Clinical manifestations The common symptoms can be divided into two main categories: local symptoms and systemic symptoms. Local symptoms Pain Lumbar pain is the most common symptom of lumbar spinal tuberculosis. Dull pain in the affected area is often present simultaneously with systemic symptoms such as low-grade fever, accompanied by pressure pain and percussion pain, aggravated by activity, coughing and sneezing, and relieved by 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 thigh’s. The pain is more pronounced when the patient changes position, especially at night when sleeping and losing the protection of muscle spasm. Postural abnormalities are 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, they cannot bend over but bend their hips and knees, and one hand holds the knee and the other hand picks up things on the floor, which is 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 of 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 advanced stages, which is a serious comorbidity that endangers the patient. Cold abscesses 70% to 80% of spinal tuberculosis is complicated by cold abscesses at the time of consultation, and paravertebral abscesses located deep in the spine can be revealed by CT or MRI radiographs. Systemic symptoms The onset of the disease is gradual, and the date of onset is not clear. Patients have generalized toxic symptoms such as lethargy, loss of appetite, afternoon fever, night sweats and emaciation. Occasionally, a small number of acute episodes of deterioration with a temperature of about 39°C are seen, which are often misdiagnosed as severe colds or other acute infections. Imaging examinations X-ray film shows mainly bone destruction and spinal space narrowing. CT examination can clearly show the site of the lesion, the presence of cavity and dead bone formation. Even small paravertebral abscesses can be detected on CT. MRI has early diagnostic value, showing abnormal signals at the stage of inflammatory infiltration, but is mainly used to observe the presence of spinal cord compression and degeneration. “It is a lesion formed by the tuberculosis bacillus eroding the lumbar spine. If you have any of these symptoms, you should seek early medical attention to avoid delaying the disease.