What Is Spinal Tuberculosis?

Spinal tuberculosis accounts for the largest number of osteoarticular tuberculosis, of which vertebral tuberculosis is the majority, and appendix tuberculosis is very rare. In the entire spine, the lumbar spine is the most active, and the incidence of lumbar tuberculosis is the highest, followed by the thoracic spine, the cervical spine, and tuberculosis and coccycosis.

Basic Information

English name: spinal tuberculosis
Visiting department: orthopedics
Common locations: Lumbar spine

Common causes: Secondary to tuberculosis, gastrointestinal tuberculosis or lymphatic tuberculosis, etc., caused by blood circulation
Common symptoms: Pain, low fever, fatigue, weight loss, night sweats, loss of appetite and anemia, etc.

Causes of spinal tuberculosis

Spinal tuberculosis is a secondary disease. The primary disease is tuberculosis, gastrointestinal tuberculosis, or lymph tuberculosis. Bone and joint tuberculosis are caused by blood circulation.

Clinical manifestations of spinal tuberculosis

General symptoms

Onset is slow, with symptoms such as low fever, fatigue, weight loss, night sweats, loss of appetite, and anemia. Children often have night crying, sluggishness or irritability.

Pain

Pain is often the first symptom. It is usually mild pain, with symptoms lessening after rest and worsening after exertion. Early pain does not ring into sleep, and the elderly may have pain at night.

3. Characteristics of cervical spinal tuberculosis

In addition to neck pain, nerve roots such as upper limb numbness are irritated. Coughing and sneezing can make pain and numbness worse. Pain is severe when nerve roots are compressed. If the pain is obvious, the patient often supports his lower jaw with both hands to tilt his head forward and shorten his neck. His posture is very typical. A posterior pharyngeal abscess prevents breathing and swallowing, and the patient has a snoring sound during sleep. In the later stage, a neck mass caused by cold abscess can be felt on the side of the neck.

4. Characteristics of thoracic spinal tuberculosis

Thoracic spinal tuberculosis has back pain symptoms. It must be noted that the pain of lower thoracic spine lesions is sometimes manifested as lumbosacral pain. Scoliosis is very common and does not come to the doctor until you accidentally find a thoracic kyphosis.

5. Characteristics of lumbar tuberculosis

When standing and walking, patients often support the waist with both hands, and their heads and torso tilt back to shift the center of gravity backwards and reduce the pressure on the diseased vertebra as much as possible. When the patient picks up objects from the ground, he can't bend down. He needs to bend his knees, bend his knees, and squat down to pick things up.

Another test method is to lay the child on his or her face. The examiner lifts both feet of the child with both hands and gently lifts both lower limbs and the pelvis. If there is a lumbar spine lesion, due to muscle spasm, the waist remains rigid and the physiological lordosis disappears.

Patients with psoas major abscess formation can be seen or felt in the lumbar triangle, popliteal or groin. Lumbar spinal tuberculosis is usually not severe, and from the thoracic spine to the sacrum, along the sides of the iliac spine muscles, you can also feel mild kyphosis by touching with your fingers in order.

Chilled abscesses may develop high fever and toxemia symptoms with secondary infection. After the rupture, a large amount of thin liquid flows out, mixed with cheese-like matter, and may also be accompanied by a small amount of dead bone. Chronic sinus is often formed after ulceration, which will last for a long time.

Spinal tuberculosis

1. X-ray inspection

(1) Bone and joint changes are mainly caused by bone destruction and intervertebral space stenosis on X-ray films. Generally, there are no positive X-ray signs within 2 months after the onset. Therefore, suspicious cases require repeated imaging or other tests. The central type of bone destruction is concentrated in the center of the vertebral body, and the lateral radiographs are relatively clear. The vertebral body soon compressed into a wedge, narrowing front and wide. It can also invade the intervertebral disc and affect adjacent vertebrae. Marginal bone destruction is concentrated at the upper or lower edge of the vertebral body and soon invades the intervertebral disc. It is manifested by the destruction of the vertebral endplate and progressive intervertebral space stenosis, which affects the adjacent two vertebral bodies. Marginal bone destruction and wedge compression are less obvious than central type, so the kyphosis is not heavy.

(2) The appearance of cold abscess On the lateral film of the cervical spine, the anterior vertebral soft tissue is widened and the trachea is moved forward. On the thoracic vertebrae, the vertebral widened soft tissue is visible, which can be spherical, spindle-shaped, or cylindrical. symmetry. On the lumbar orthotopic film, the psoas major abscess manifests as a shadow of the psoas major muscle on one side, or the psoas major shadow becomes widened, full, or localized. The abscess can even flow to the hip and femoral triangle. Large amounts of calcified shadows can be seen in chronic cases.

2.CT inspection

The location of the lesion can be clearly shown, with voids and dead bone formation visible. Even small paravertebral abscesses can be found on CT. CT examination has unique value in finding psoas abscess.

3.MRI (magnetic resonance) examination

It has early diagnostic value, can display abnormal signals during the inflammatory infiltration phase, and can also be used to observe the spinal cord for compression and degeneration.

Spinal tuberculosis diagnosis

It is not difficult to make a clinical diagnosis based on medical history, clinical manifestations, physical signs, X-ray films, CT, MRI, and laboratory tests.

Spinal tuberculosis treatment

Non-surgical therapy

Decide whether to perform surgery according to the indication of surgery. Even for those with surgical indications, non-surgical treatment is required for 2 to 4 weeks as a preoperative preparation. Non-surgical treatment includes systemic antituberculosis treatment and local braking. Generally, two anti-tuberculosis drugs are used in combination. After 3 to 6 months, the treatment is changed to a single anti-tuberculosis drug. The entire course of treatment should be no less than 2 years. Partial braking is fixed with a plaster vest (thoracic and upper lumbar tuberculosis) and a cast thigh (lower lumbar tuberculosis) on one side of the plaster waist band. The fixed period is 3 months, and bed rest should be used during the fixed period. Those who cannot tolerate gypsum fixation on the whole body can sleep on a special gypsum bed for 3 months.

2. Surgery

(1) Excision and drainage of pus . Excessive infusion of cold abscess causes secondary infections in patients. The symptoms of systemic poisoning are obvious. Incision and drainage can not be tolerated to save lives. After the cold abscess is cut, the symptoms of systemic poisoning are expected to be controlled, but the incision is extremely difficult to heal. Because the abscess is extremely deep, it is mostly cut open at the top of the abscess, and drainage is not smooth. You can irrigate the pus cavity with 4% isoniazid solution every day and keep the sinus openings open. You can insert a thick rubber tube to expand the sinus opening, or use a double cannula to drain. Take care not to let foreign objects such as leather tubes and cotton balls fall into the pus cavity. Cold abscesses without secondary infection should not be treated with open pus drainage. Due to extensive scar tissue formation and inflammatory infiltration around the formed sinus, the anatomical structure is unclear, so it is not advisable to perform fistula resection to avoid damage to adjacent blood vessels, nerves or important organs. It is also not advisable to perform stratified puncture drainage and injection of anti-tuberculosis drugs for cold abscesses.

(2) Lesion removal surgery Since the 1940s and 1950s, the successful synthesis and extraction of antituberculosis drugs provided conditions for the implementation of lesion removal surgery. There are two types of anterior and posterior procedures. Posterior surgery is usually used for thoracic spinal tuberculosis. Cervical spinal tuberculosis is mostly removed from the anterior approach, and plaster is fixed for 3 to 4 months after surgery. After review, the plaster is removed or continued to be fixed as appropriate.

(3) Posterior spinal fusion surgery The combined application of posterior pedicle screw system and anterior lesion removal surgery can enhance the stability of the spine and allow patients to get out of bed early, and the plaster vest can be fixed 3 to 6 months after surgery.

(4) Anterior spinal fusion surgery When the lesions are removed, bone grafting and anterior internal fixation are performed to achieve the purpose of stable spine and facilitate bone graft fusion.

(5) Orthopedic surgery is mainly to correct spinal kyphosis.

Prognosis of spinal tuberculosis

Generally, antituberculosis treatment before and after surgery, surgical lesion removal and internal fixation, bone healing at the lesion site, the patient's symptoms disappear, and the clinical recovery.