Spinal tuberculosis kyphoscoliosis
Introduction
Introduction to the deformity of spinal tuberculosis Spinal tuberculosis, especially in children over 10 years old, is one of the serious sequelae, which not only affects the patient's appearance and patient's psychological stress, but also severely deformed thoracic or thoracolumbar tuberculosis, which may affect the cardiopulmonary function, and may also have late onset. The lesion is cured by paraplegia. The age of the patient at the start of treatment has an important effect on the extent of progressive dysplasia. In patients with completed spine growth, most of the dysplasia occurred within 12 months of treatment and there was almost no progressive increase in the following 2 years. basic knowledge The proportion of sickness: 0.002%-0.003% Susceptible people: children aged 10 years old Mode of infection: respiratory transmission Complications: paraplegia
Cause
Causes of stenosis after spinal tuberculosis
The etiology of this disease is more complicated, a variety of factors can cause kyphosis, affecting the posterior kyphosis of the spine including the following factors: the age of the patient, the initial kyphosis angle, the number of affected vertebral bodies, the total number of vertebral bodies lost during treatment And the level of the spine where the lesion is located.
Prevention
Spinal tuberculosis
The disease is mainly caused by the transfer of tuberculosis bacteria to the spine. Therefore, actively treating tuberculosis and preventing the spread of tuberculosis are the key to the prevention and treatment of this disease. In addition, we must pay attention to proper exercise and enhance the resistance of the opportunity.
Complication
Postoperative complications of spinal tuberculosis Complications
The disease not only affects the patient's appearance and patient's psychological stress, but also severely deformed thoracic or thoracolumbar tuberculosis, which will affect the cardiopulmonary function, produce complications of cardiopulmonary organs, and may also have more serious symptoms such as late-onset lesions and paraplegia. complication.
Symptom
Spinal tuberculosis dysplasia symptoms common symptoms torso deformity curved posterior spine
The level of the spine where the lesion is located has a significant influence on the degree of kyphosis. Similarly, the vertebral body is destroyed, and the lesion is more severe in the thoracic or thoracolumbar spine than in the lumbar spine.
1, lumbar vertebra 4 or lumbar vertebrae 5 lesion damage or even a complete loss of the vertebral body, has little effect on the spine protrusion, may be compensated by the original lumbar lordosis.
2, thoracic or thoracic tuberculosis caused by one or two, three vertebral bodies completely missing, and finally will form a 30 ° ~ 90 ° post-severe deformity, this group of 23 cases (46%), the dysplasia of 70 Around °, about the disappearance of a single vertebral body destruction, the final posterior deformity will be 33 ° in the thoracic vertebra, 37 ° in the thoracic and lumbar vertebrae, and only 24 ° in the lumbar vertebrae, there is a significant difference, severe kyphosis (> 100 ° ) seems to focus on the lower segment of the thoracic spine.
3. The age of the patient at the beginning of treatment has an important influence on the degree of progressive stenosis. Patients with completed spine growth and development, most of the stenosis appear within 12 months of the treatment period, and almost no progress in the following 2 years. Increased, growth and development of children, the initial posterior deformity <40 °, the lesion in the thoracolumbar or lumbar vertebra followed by its posterior deformity can be reduced or unchanged; otherwise the initial posterior deformity > 40 °, with the child's spine development, after The dysplasia will increase progressively.
Examine
Examination of stenosis of spinal tuberculosis
(1) X-ray film
In the early stage of the disease, it was mostly negative. According to Lifeso et al. (1985), it was considered that after 6 months of onset, when the vertebral bone was 50% involved, conventional X-ray films could be displayed.
Early signs of X-ray film showed that in most cases, the paravertebral shadow was enlarged, with the anterior and posterior margin of the vertebral body, and the intervertebral space was narrowed, the vertebral body was sparse, the paravertebral shadow was enlarged, and the dead bone was observed. If the diameter of the vertebral bone destruction area is <15mm, the lateral position film can not be displayed, and the diameter of the body slice destruction area can be detected at about 8mm. Large and small dead bones can be seen in the cancellous bone or abscess of the vertebral body.
In the central vertebral tuberculosis vertebrae, there is no obvious change in the intervertebral space, which is difficult to distinguish from vertebral tumors; while some slow-growing tumors such as thyroid metastasis, chordoma and malignant lymphoma can show different degrees of intervertebral stenosis. It is very difficult to distinguish from sacral vertebral tuberculosis.
In general, cases of vertebral tuberculosis, except for those who are old or will be cured, the paravertebral shadows are mostly bilateral. However, spinal tumors such as vertebral giant cell tumor, chordoma, malignant lymphoma and renal cancer spinal metastasis, etc., can be seen on the unilateral or bilateral expansion of the paravertebral shadow on the orthotopic radiography, especially limited to one side, should Pay attention to the identification.
(two) CT examination
Early detection of subtle bone changes and the extent of abscesses is more valuable for areas where the conventional X-ray films such as the annulus, cervical thoracic vertebrae, and irregularly shaped atlas are not easily satisfactory. Some scholars have divided the images of CT of spinal tuberculosis into four types: 1 fragment type: small fragments are left after the destruction of the vertebral body, and there are low-density soft tissue shadows on the vertebrae, which often have scattered small fragments; 2 osteolytic type: vertebra There is an osteolytic destruction zone at the leading edge or center; 3 subperiosteal type: uneven vertebral destruction at the anterior edge of the vertebral body, annular or semi-circular calcification images often seen in paravertebral soft tissue; 4 localized bone destruction type: destruction There is a hardening zone around the area (Jainr et al. 1993).
CT scan of spinal tuberculosis is the most common type of fragmentation, and spinal tumors are often similar. Therefore, comprehensive analysis should be combined with clinical data, such as the expansion of the paravertebral shadow, when there is calcification or small bone fragments, it helps spinal tuberculosis. Diagnosis. Despite this classification, CT sometimes cannot identify spinal tuberculosis such as spinal tumors.
(3) MRI examination
It has the characteristics of high resolution of soft tissue and is superior to CT in brain and spinal cord examination. It can be scanned in the sagittal, axial and coronal planes. Spinal tuberculosis MRI showed that the vertebral bodies, discs and attachments of the lesions were higher than the normal signals at the corresponding vertebrae, and the lower ones were lower signals.
1. Vertebral lesions: T1-weighted images show a low signal at the lesion, or a short T1 signal. T2-weighted images of vertebral lesions showed signal enhancement. The image shows that in addition to the signal change of the diseased vertebral body, the contour of the vertebral body destruction, the in-line change of the vertebral body collapse and the enlarged paravertebral image are observed.
2. Paraspinal abscess: Spinal tuberculosis paraspinal abscess shows a low signal in the T1-weighted image, while the T2-weighted image shows a higher signal. The coronal plane can depict the contour and extent of a paraspinal abscess or bilateral psoas abscess.
3. Intervertebral disc changes: Spinal tuberculosis X-ray film disc narrowing is one of the early signs. The T1-weighted image of the MRI exhibits a low-signal narrowed disc. In the normal nucleus pulposus, there is a transverse gap in the T2-weighted image. When there is inflammation, the fine gap disappears, and the inflammation of the intervertebral disc can be detected early.
The diagnosis of early spinal tuberculosis by MRI is more sensitive than any other imaging examination including ECT. The clinical symptoms appeared for 3 to 6 months. Patients with suspected spinal tuberculosis had no abnormalities on X-ray films. MRI showed the affected vertebral body and paravertebral soft tissue (abscess). The T1-weighted image was low signal and the T2-weighted image was high signal. Early MRI images of spinal tuberculosis can be divided into three types. 1 vertebral body inflammation; 2 vertebral inflammation combined with abscess; 3 vertebral inflammation, abscess combined with discitis. It is worth mentioning that the affected vertebral body is in the inflammatory phase, and no soft tissue and intervertebral disc signal changes can not be differentiated from vertebral tumors. If necessary, biopsy should be confirmed.
Diagnosis
Diagnosis and diagnosis of stenosis of spinal tuberculosis
diagnosis
There are many reasons for the kyphosis deformity, which can be clearly diagnosed by X-ray examination and tuberculin examination.
Diagnose based on
(1) History of tuberculosis or contact with tuberculosis patients.
(2) There are symptoms of tuberculosis such as low-grade fever, night sweats, loss of appetite, weight loss, and fatigue.
(3) Pain, tenderness and sputum pain in the spinal lesions. There may be a posterior horn deformity, limited spinal activity, and a positive sample test.
(4) There may be cold abscess formation. Cervical tuberculosis is often in the posterior pharyngeal wall; thoracic tuberculosis is mostly in the paravertebral; lumbar tuberculosis can be seen in the groin, the medial side, the lumbar triangle or the buttocks in addition to the psoas muscle abscess. If the cold abscess ruptures, it can form a sinus and long-term unhealed.
(5) Spinal tuberculosis combined with paraplegia, incomplete or complete paraplegia below the spinal compression plane.
(6) ESR increased during the active period of tuberculosis.
(7) Positive X-ray of the spine, showing irregular bone destruction of the vertebral body, or collapse of the vertebral body, cavity, formation of dead bone, narrowing or disappearing of the intervertebral space. There is a cold abscess shadow on the paravertebral.
(8) CT examination or MRI examination can show the extent of lesions, intraspinal lesions and spinal cord compression.
Differential diagnosis
In clinical practice, this disease mainly needs to be differentiated from other types of spinal deformity.
