What is Spinal Tuberculosis
Spinal tuberculosis is the most common bone and joint tuberculosis, blood infection. It occurs in children and young people, the highest incidence of 20 to 29 years old. Accounted for 36.6%, the the most to lumbar, thoracic spine, followed by neck oak least. But children are more common thoracic tuberculosis, involving several vertebrae and intervertebral disc after the sudden prone. Yi Yi children more common cervical tuberculosis, good hair in the first and second cervical vertebrae, could easily lead to pathological dislocation. Adults occur in the lumbar spine, generally involves two adjacent vertebral bodies, many not so obvious after the sudden.
Symptoms of Spinal Tuberculosis
Clinical manifestations of spinal tuberculosis
Systemic symptoms of spinal tuberculosis
Disease from the implicit gradually, the date of onset is not clear. Patients with fatigue, weakness, loss of appetite, afternoon fever, night sweats and weight loss and other symptoms of systemic poisoning. Occasionally, a small number of acute exacerbation exacerbation. Temperature 39 ℃ born right misdiagnosed cold or other acute infection. On the contrary, there are cases none of the above fever and other systemic symptoms, only a sense of the affected area to dull pain or radiating pain misdiagnosed as other diseases.
Local symptoms of spinal tuberculosis
(1) pain: the surface of the skin dull pain, fever and other systemic symptoms more than the same time in activities, car shock, coughing, sneezing worse. Relieve after bed rest; aggravation of pain at night, pain along the spinal nerve radiology, radiation to the rear upper cervical occipital, under the cervical radiation to the shoulder or arm, thoracic along the the intercostal nerves radiation first, the lower abdomen, often misdiagnosed as cholecystitis, pancreatitis , appendicitis. Lower segment L11 ~ 12 along the inferior gluteal nerve radiation to the waist or hips, lumbar piece multi-only camera in this X-ray examination, and thus the lower thoracic lesions often missed. Lumbar spine along the lumbar plexus multi radiating to the front of the thigh, even involved the rear legs, often misdiagnosed as intervertebral disc herniation.
(2) abnormal posture: pain resulting paravertebral muscle spasms caused. The cervical tuberculous patients often torticollis, forward head, neck shortening and both hands jaw. Chest protruding abdominal posture common in the the chest lumbar or lumbosacral structure of.
Normal people can stoop pick up objects, illness could not bend over, but the hip flexor knees, one hand on knee the other hand Qushi ground something, call it pick up objects test positive. Young children can not stretch, can address its prone, check by hand to lift its feet, the normal spine was curved natural extension, while children with disease the intervertebral fixed or paraspinal muscle spasm, waist could not extension.
(3) spinal deformity: cervical and lumbar pay attention to whether the physiological protrusion suddenly disappear, after thoracic or without physiological increase. Top-down palpable each spinous process with or without abnormal prominent angled protrusion foot special limitations, more common in the ridge Azusa tuberculosis, vertebral epiphyseal rickets and youth, ankylosing spondylitis, poor posture arc formed sudden and round the back are different.
(4) cold abscess: treatment when 70% to 80% of spinal tuberculosis and technology have cold abscess, paraspinal abscess located in the depths of the spine by means of x-ray radiography, CT or MRI shows. Abscess along the the muscle fascia gap or neurovascular beam Note to the body surface. Along the intercostal nerve ring atlantoaxial lesions pharyngeal abscess caused difficulty swallowing or breathing disorders;, under cervical the abscess appeared anterior or posterior triangle; thoracic tuberculosis vertebral side rendering tension spindle or columnar abscess vascular the Cambodian flow injection to the chest and back, and even can penetrate the lungs and chest cavity, a rare perforation of the esophagus and thoracic aorta; thoracolumbar abscess of the lumbar spine along one side or both sides of the iliolumbar myofascial or in fact questioned flows downward Note small retroperitoneal, even penetrate the colon fixed organ down does not make progress to the iliac fossa, groin, buttocks, or legs; sacral vertebrae the pus often gathered in front of the sacrum or to the femur along the Piriformis through the greater sciatic foramen near the greater trochanter the master the cold abscess streamer way and it appears parts to be helpful in the diagnosis.
(5) sinus: cold abscess expandable surface treatment can be self-absorbed or self ulceration Rong into a feast Road. Sinus secondary infection, the disease will increase, difficult to treat, and the prognosis is poor, should be avoided.
(6) spinal cord compression: tuberculosis of the spine, particularly the cervical spine tuberculosis cone over who should pay attention to the presence or absence of spinal cord compression, limbs, neurological dysfunction, for early detection of complications of spinal cord compression.
What Causes Spinal Tuberculosis
The cause of spinal tuberculosis
Spinal tuberculosis is a secondary lesions, that is a local manifestation of systemic tuberculosis, the original tumor in the lungs, a few in the lymph nodes, digestive and urogenital based. Mycobacterium tuberculosis belong to the the schizont bacteria Gang, Actinomycetales, Mycobacterium Mycobacterium tuberculosis is divided into bovis people, birds and Murine four. Humanoid and Mycobacterium bovis is the main pathogens of human tuberculosis. Mycobacterium tuberculosis shape slender, slightly curved, rounded at both ends. Long-term survival of Mycobacterium tuberculosis in a dry environment can not die, more sensitive to hot and humid.
The human body after the initial infection of tuberculosis, spinal tuberculosis change soon extended to the regional lymph nodes, TB and then spread throughout the body through the lymph nodes to enter the blood supply. 3 to 9 weeks after the body of M. tuberculosis and its metabolites intrusion anaphylactic or immunity, the tuberculin test from negative to positive. Serum antibodies and intracellular antibodies after infection. TB becomes caseous necrosis often occurs. The caseous necrosis generation may be due to the local accumulation of inflammatory cells, oppression capillaries, causing ischemic dirty immortality; related to allergic reactions caused by the bacterial protein. Caseous tissue rarely attract white blood cells, therefore, often do not have the characteristics of general purulent infection. Corruption debris unlike most necrotic tissue as soon phagocytes carried away caseous tissue autolysis is suppressed, resulting in long-term is not absorbed. The caseous organization typically acidic reaction, sometimes the pH value can be as low as 4.0. The caseous tissue softening, the pH value is gradually increased, the conversion to alkaline. caseous tissue easy calcification by raising the pH. The caseous lesions after softening, absorption, fibrous tissue hyperplasia and cure, or calcification and cure. Although fibrosis or calcified lesions, still of Mycobacterium tuberculosis earners live, at rest. Softened cheese-like substance often with pus flow out to other parts of the body and cause new lesions. When human illness, poor nutrition, mental depression or receive chemotherapy, radiation therapy and immunosuppressive therapy, body resistance bacilli through the bloodstream or lymphatic reach the cervical localized, original local cervical latent or stationary lesions can also be re-cervical tuberculosis activities together. Many children not infected with tuberculosis, Mycobacterium tuberculosis resistance is weak, not only easy to develop the disease after infection, and tend to spread child neck water tuberculosis incidence the junction recovery activities period. Cervical tuberculosis can occur in the activities of primary epileptic foci, can also be formed in the primary lesion still children even months, years or decades of onset. Cervical tuberculosis incidence of chronic cervical strain or cumulative injury. Clinical proved traumatic fracture, dislocation or sprain were not induced in the local tuberculosis. The largest number of cases of tuberculosis in the trunk all the bones in the spine and spine may load up on. From the spine itself, the lumbar load up, the number of cases so the lumbar up. The lower extremity weight-bearing than upper leg number of cases is more than the upper limbs. From the above in view of the fact that a certain strain of the disease occurred.
Tests and Diagnosis for Spinal Tuberculosis
The diagnosis of spinal tuberculosis
1. Spinal tuberculosis x ray
Early in the disease, mostly negative, according to Lifeso (1985) observed that about six months after the onset, conventional X-ray can show vertebral bone 50% involvement.
X-ray early signs the first paravertebral shadow expand in most cases, with the involvement of the anterior lower edge and intervertebral narrowing, vertebral bone thinning, paraspinal the shadows expand and sequestrum. Vertebral bone destruction Medical diameter <15mm lateral radiography shows damage zone layer radiography will be able to find out about 8mm in diameter. The visible size sequestrum vertebral cancellous bone or abscess.
In the central vertebral Results pyramids, intervertebral multi no significant changes, it is difficult to identify with vertebral tumors; while some slow-growing tumors such as thyroid metastasis, chordoma and malignant lymphoma, but it can display varying degrees of intervertebral narrow epiphyseal vertebral tuberculosis is very difficult to identify.
Usually the vertebral tuberculosis cases except obsolete or will cure patients, paravertebral the shadows expand bilateral. Spinal tumors such as vertebral bone giant cell tumor, chordoma, malignant lymphoma and kidney cancer spinal metastasis in anteroposterior X-ray radiography visible unilateral or bilateral expand paravertebral shadow. Limited to one side, special attention should be identified.
CT examination of spinal tuberculosis
The early detection of subtle bone changes and abscess of the scope of conventional x-ray camera ring atlantoaxial cervical spine and sacral irregular shape site more valuable piece is not easy to obtain satisfactory images. Scholars tuberculosis of the spine CT image is divided into four types: ① debris type
Vertebral body destruction leave a small debris, its low-density soft tissue shadow paravertebral, which often scattered in small pieces; ② osteolytic type
Vertebral osteolytic area or center; ③ subperiosteal
Anterior vertebral the jagged bone destruction, the paravertebral soft tied organizations often visible ring or semi-annular calcification; ④ limitations bone damage type
Around the damaged areas of hardened zone.
Tuberculosis of the spine CT examination of the debris type is the most common spinal tumor often contrast similarities, it should be combined with a comprehensive analysis of clinical data, such as paravertebral expanding shadow the calcification stoves or small Gusui of little help spinal tuberculosis diagnosis. Nevertheless, genotyping, CT sometimes still can not identify tuberculosis of the spine, such as spinal tumor.
Characteristics with a high resolution of soft tissue, brain and spinal cord check superior to CT, can scan imaging in spinal sagittal plane, axial plane and crown surface. The vertebral tuberculosis of the spine MRI manifestations of the disease, compared to between disk and accessories and ended often corresponding to the spine at the normal signal, higher than those for the high signal lower than those for the low signal.
(1) vertebral lesions; T1-weighted image shows the lesion of low signal, or associated with short T1 signal. Vertebral lesions T2-weighted images show signal enhancement. The image display vertebra addition to the signal change, we can see the contours of the vertebral body destruction, vertebral collapse-line change and expand paravertebral image.
(2) paraspinal abscess; tuberculosis of the spine paraspinal abscess show low signal on T1-weighted images, T2-weighted images showed a high signal. Crown surface can depict the contours and scope of the paraspinal abscess or bilateral psoas abscess.
(3) change the intervertebral disc: tuberculosis of the spine X-ray radiography rooms disc narrowing is one of the early signs. MRI T1-weighted image presents a low signal narrowing of the intervertebral disc. Normal nucleus pulposus the inherent T2-weighted like thin gap, rampant inflammation fine gap disappears, early detection of inflammatory changes of the intervertebral disc.
MRI diagnosis of tuberculosis of the spine in the early ECT, including more sensitive than any other imaging studies. Clinical symptoms appear 3 to 6 months, spinal tuberculosis patients suspected within the x-ray abnormalities, MRI can show the involvement of the vertebral body and paraspinal soft tissue (abscess), T1-weighted images for low signal, T2-weighted images, high signal. Early MRI imaging of spinal tuberculosis can be divided into three types: ① vertebral inflammation; ② vertebral inflammation merge abscess; ③ vertebral inflammation, abscess complicated intervertebral disc inflammation. Is worth mentioning that the inflammation of the affected vertebra is, without soft tissue and disc signal changes, vertebral tumors can not be differentiated, if necessary biopsy confirmed.
The differential diagnosis of spinal tuberculosis
1 disc degeneration
Age of about 40 years of age, especially manual workers is common in the cervical and lumbar spine, the performance of the affected area of chronic pain and belongs nerve roots radiating pain. X-ray piece interbody narrow, adjacent vertebral edge dense, or lip-like proliferative changes, paravertebral no expansion of the shadow of the patient's body temperature and erythrocyte sedimentation rate.
Congenital vertebral malformations more common in the 16 to 18-year-old, low back pain, appearance or scoliosis deformity. X-ray visible hemivertebrae, the vertebral wedge change or adjacent visible deformity of the ribs on both sides of the pedicle transverse process, the ribs of an unequal number of interbody fusion or indole type of congenital malformations should cure type identification of vertebral tuberculosis.
3 lumbar disc prolapse
More common in the 20 to 40-year-old male, low back pain and sciatica, pain aggravated when coughing. The prosecution Eagle visible lumbar scoliosis, lordosis decreased or disappeared, ipsilateral straight leg raising test was positive, but the erythrocyte sedimentation rate and body temperature were normal. L4 ~ 5 or L5 ~ S1 tuberculosis rear side of the lesion is often associated with confusion.
Systemic and local symptoms the pyogenic spondylitis less dramatic, a wide range of pain increased from the lumbosacral rheumatoid factor positive serum mucin and anti-"o".
5. Spine suppurative inflammation
Prior to the onset of spinal tuberculosis patients with a broad surge in skin boils, swelling or other purulent foci disease, high body temperature, symptoms of poisoning called significant involvement pain, limited mobility, soft tissue swelling and tenderness. X-ray piece the vertebral visible bone destruction, intervertebral narrowing often sequestrum formation, multiple abscess formation, bacterial and histological examination confirmed.
6. Spontaneous ring axial dislocation
Often secondary to pharyngeal inflammation. Children under 10 years of age, children commonly hand lift up jaw, torticollis, neck, limited mobility, the X-ray ring vertebral forward dislocation of dens to the lateral or posterior displacement without bone destruction, cold abscesses shadow. CT examination can help diagnosis.
7. Flattened vertebrae
More common in children, and the performance of back pain, kyphosis, spinal movement is limited, no systemic symptoms, the disease is common cause: vertebral addicted Yihong granuloma and osteochondrosis. x-ray a risk of vertebral wedge coup, may remain a thin sheet of the adjacent intervertebral normal, visible paravertebral slightly expanded shadow lesion cure vertebral height is more than can be varying degrees of recovery.
8. Spine tumor
Can be divided into primary and metastatic two categories.
(1) Primary: common 30-year-old BU patients, the common benign giant cell tumor, osteochondroma, vascular tumors, malignant lymphoma, chordoma, Ewing's sarcoma.
Neuroblastoma is more common in the 5-year-old vase (2) metastatic cancer: more common in patients 50 years of age, lung cancer, breast cancer, kidney cancer, liver cancer, thyroid cancer, prostate cancer, metastasis to the vertebral body or attachments young children.
Treatments of Spinal Tuberculosis
Treatment of spinal tuberculosis: application of supportive therapy, drug therapy, minimally invasive therapy, anti-TB, if necessary, surgery to remove the lesion, fusion of the spine, to restore the health of the patient at an early date. However, any treatment method has its unique indications for spinal tuberculosis patients to choose their own treatment the most important.