Patient: Description of the condition (onset time, main symptoms, hospital visited, etc.): male, 75 years old, patient felt lumbar pain, walking difficulty, no hot flashes and night sweats since July 15, 2011, hospitalized on July 21, 2011, examination of lumbar spinal process pressure pain, normal physiological reflexes of the lower limbs, normal muscle tone; MR showed L5 vertebral destruction, chest X-ray showed pulmonary fibrosis, blood sedimentation 90mm/h, C-reactive protein ( CRP (CRP) 79.9mg/h, tumor-related antigen, alpha-fetoprotein, carcinoembryonic antigen, total prostate-specific antigen and other test reports are normal without high whole-body bone imaging report: 1. The right side of the 1st thoracic rib joint bone salt metabolism is active, consider degenerative lesions 2. Further examination 3. the rest of the skeleton did not see obvious abnormalities MR manifestations: lumbar vertebrae in line with good, physiological curvature straightening, the country 4/5 intervertebral disc to the right posterior protrusion, the corresponding horizontal segment of the hard spinal lumbar compression, the right intervertebral foramen narrowing, nerve root compression, thickening of the yellow ligament. Lumbar 5 vertebral body slightly compressed and flattened, slightly wedge-shaped changes; and lumbar 4/5 vertebral body and lumbar 4 right accessory, lumbar 5 right arch root are seen abnormal signal shadow, T2WI is slightly high signal, T1WI is generation signal, enhanced with significant enhancement; bilateral lumbar major muscle pin swelling, lumbar spine right side of the muscle is also seen swelling, enhanced with circular reinforcement considered: 1. lumbar nodal vertebra 2. tumor Give diagnostic anti-tuberculosis treatment. Isoniazid, rifampicin, pyrazinamide, ethambutol Combined medication No pain in the lumbar region after about 10 days; rechecked hematocrit 77 mm/h C-reactive protein (CRP) 56.8 mg/h After continuous anti-tuberculosis treatment for about 40 days, MR was rechecked on September 8: physiological curvature of the lumbar spine still existed, L5 vertebrae showed compressive changes, L4, L5 vertebrae and their accessories had abnormal signal, T2WI was heterogeneous The L4/5 vertebral disc is herniated posteriorly on the right, the dural sac is compressed at the corresponding horizontal segment, the right intervertebral foramen is narrowed, and the nerve roots are compressed; the lumbar 4 and 5 vertebral bodies and their attachments have abnormal signal changes and the lumbar masseter and erector spinae muscles are swollen bilaterally with abnormal signals, and tuberculosis is considered. Now I have been taking the above anti-tuberculosis drugs at home, and I have been resting in bed, and the doctor suggested that I should review it after one month. Since I have been taking anti-tuberculosis drugs for about 10 days, I have no pain, and my blood sedimentation C-reactive protein has decreased slightly. But why does the MR show that the bone destruction is getting worse? From the marginal destruction of the L4/5 vertebrae, the bone destruction has now spread to the entire L4 and L5 lumbar vertebrae? Is it tuberculosis or tumor? If it is tuberculosis, how long do I have to take medication to get better? Is it possible to confirm? Is surgery possible? Additional point: no cold abscess was found for the time being JU Hongbin, Department of Spine Surgery, Guangzhou First People’s Hospital: The symptoms, signs and examinations provided are very detailed. I would first consider the possibility of tuberculosis. Because there is a lumbar muscle abscess, imaging performance of the vertebral space narrowing, the upper and lower vertebrae also have signal changes, and then there is an effect of anti-tuberculosis, and the indicators have decreased. The reason for not considering it as a tumor is that in 70-year-old patients, if it is a tumor, most of them are metastatic tumors, and the tumor index is not high. In addition, most of the tumors invade the vertebral arch, and the invasion seen on imaging is the intervertebral space. Guangzhou First People’s Hospital spine surgery JU Hongbin: Suggest that you look back to the original doctor who saw you, I think he is a very good doctor, gave you a diagnosis of the disease, and gave the correct treatment. As for whether to operate or not, there is currently a big controversy in the academic world. If you were my patient, I would combine all your circumstances and would recommend that you take your medication on an outpatient basis and review it regularly. Patient: Thank you very much for your careful analysis and your valuable advice! The patient is now taking medication on an outpatient basis, and will be admitted to the hospital for review in the near future. Thank you! Now the patient is losing weight, how should I take care of her body? For example, diet? The patient is basically pain-free, can he get up and sit or walk in a small range of motion? Guangzhou First People’s Hospital Spinal Surgery Department JU Hongbin: Generally speaking, getting out of bed requires protection, domestic use of lumbar girth, I recommend the use of TLSO, thoracolumbosacral brace protection, a small range of motion, so relatively safe. Never be careful not to be subjected to external forces, especially if the patient does not follow medical advice and does not wear a brace for protection. Diet, it is up to the patient and family members to try their best to eat nutritious food so that the body can get better. Patient: Thank you very much for your valuable advice Ju Hongbin, Department of Spine Surgery, Guangzhou First People’s Hospital: You’re welcome, it’s a pleasure to answer some questions for you. Patient: Hello doctor! The above disease patients to the hospital today to review, blood sedimentation 62mm/h, (normal value of 0-20mm/h), compared with a month ago down 15mm/h; C-reactive protein (CRP) 18.6mg/h (normal value of 0-10mg/l), compared with a month ago down before 38.2mg/h; P These two have significantly decreased; but liver function two to half: 1, 4, 5 items are positive ( Is it a small triple yang?) What should I do now? Do I need to adjust the treatment plan? How to adjust? Now I am using: isoniazid, rifampin, pyrazinamide, ethambutol, plus hepatocyte tablets, please give me your advice! Thank you very much! Guangzhou First People’s Hospital Spinal Surgery Department JU Hongbin: I don’t know why you checked the liver function two pairs of half: 1, 4, 5 items are positive (is it a small triplet?) We usually check the liver function, usually only look at the transaminases oh. Glutathione aminotransferase and glutathione aminotransferase. As for whether hepatitis B is a major or minor third-positive, it has little to do with this liver function. If you want to know that, if the results are in the same order as our hospital, it is more likely to be a major triplet, but this mention has not been mentioned for a long time oh, this is the east of the infectious disease department. Pay close attention to the dynamics of your glutathione and glutathione transaminase changes. Avoid too much anti-tuberculosis drugs that damage liver function.