Overview
The incidence of spinal tuberculosis combined with paralysis is about 10%, with paraplegia occurring most frequently in thoracic tuberculosis, followed by quadriplegia in cervical tuberculosis. The lumbar spinal canal is wide, and its content is cauda equina, so lumbar tuberculosis complicating cauda equina compression is extremely rare. Tuberculosis of the vertebral appendages is rare, and once it develops, paraplegia is likely to occur.
Etiology
As spinal tuberculosis destroys the vertebral body, resulting in compression of the vertebral body, pus, tuberculosis granulation tissue, caseous necrotic material and dead bone enter into the spinal canal, compressing the spinal cord and causing paralysis.
Symptoms
In addition to the systemic symptoms and local manifestations of spinal tuberculosis, there are also clinical manifestations of spinal cord compression. The first symptom is the sensation of girdle. The site of the banding sensation is consistent with the lesion segment, which is the result of nerve root stimulation. Motor disorders, sensory disorders, and urinary and fecal dysfunction appear successively. Taking thoracic spine tuberculosis as an example, usually the onset is slow, and firstly, the lower limbs are weak, and it is very laborious to walk uphill, and there is a feeling of stepping on the quilt when walking. Walking is stiff, trembling and weak, and also easy to trip. Finally walking scissor steps, a spastic state, need to use crutches to assist walking, until bedridden or dependent on a wheelchair life. There are also cases of acute spinal cord compression produced by a large amount of pus pouring into the spinal canal, which manifests as flaccid paralysis of the lower extremities due to spinal shock, and develops into spastic paralysis when the shock is corrected. In cases of cervical tuberculosis, neurologic dysfunction of the upper extremities may occur. A plane of sensory deficit consistent with the focal segment can be tested on examination. Urinary and faecal dysfunction is dominated by dysuria, initially as urinary retention, where there is an urge to urinate but the urine cannot be voided; after recovery of bladder reflexes, urinary incontinence is manifested. Fecal dysfunction is usually mild, with constipation and abdominal distension; fecal incontinence is rare.
Examination
1. Increased erythrocyte sedimentation rate.
2. CT and MRI examination
It can show the site of the lesion, the compression situation, and on MRI slices, it can also observe the spinal cord with or without abnormal signals due to liquefaction to help estimate the prognosis.
Diagnosis
Based on the history, clinical manifestations, X-ray, CT and MRI examinations, the diagnosis is not difficult.
Treatment
In principle, all patients with spinal tuberculosis who have neurological symptoms and spinal cord compression detected by imaging should undergo surgery, and they should be adequately treated with anti-tuberculosis drugs before surgery. For some patients who cannot tolerate surgery, non-surgical treatment is feasible, and surgery should be pursued when the condition improves.
Prognosis
With early diagnosis and early surgical removal of the lesion, paraplegia can often be mostly or partially recovered.