simple spinal tuberculosis
Introduction
Introduction to simple spinal tuberculosis Spinal tuberculosis accounts for the first place in the system of bone and joint tuberculosis, of which vertebral tuberculosis accounts for the majority, and accessory tuberculosis is very rare. The vertebral body is mainly osteoporosis, which is negative and bears high stress. The trophoblasts of the vertebral body are mostly terminal arteries, and the tubercle bacilli easily stay in the vertebral body. Among the entire spine, the lumbar spine has the highest activity, and the incidence of lumbar tuberculosis is also the highest, followed by the thoracic vertebrae and the cervical vertebrae. The sputum and caudal tuberculosis are rare. The disease is more common in children, and the incidence of people over the age of 30 is significantly reduced. basic knowledge The proportion of illness: 0.054% Susceptible population: more common in children Mode of infection: non-infectious Complications: spondylitis
Cause
Simple spinal tuberculosis
Classification (30%)
(1) Central vertebral tuberculosis: more common in children under 10 years old, occurs in the thoracic vertebrae, the lesion progresses rapidly, the whole vertebral body is compressed into a wedge shape, and only one vertebral body is invaded. When the lesion progresses, it will penetrate the intervertebral disc and involve Near the vertebral body.
(2) marginal vertebral tuberculosis: more common in adults, lumbar vertebrae is a good site, lesions are limited to the upper and lower margins of the vertebral body, and quickly invade the intervertebral disc and adjacent vertebral bodies, disc destruction is the characteristics of this disease, Thus the intervertebral space is very narrow.
(3) vertebral body type: can also be called "subperiosteal type", mainly because the peritoneal or pelvic tuberculosis lesions directly invade the front of the vertebral body, causing the frontal bone edge to be worm-like damage, this type is rare, However, the incidence of lumbar spine is high.
Cold abscess (30%)
(1) paraspinal abscess: pus is collected in the vertebral body, can be in front, rear or both sides, to accumulate on both sides and the front is more common, pus will pick up the periosteum, can also go up along the ligament gap Spread down, causing bone erosion on the edges of several vertebral bodies, it can also enter the spinal canal to the rear, compressing the spinal cord and nerve roots.
(2) flow abscess: after the paravertebral abscess accumulates to a certain amount, the pressure increases, will penetrate the periosteum constraint, flow down the muscle fascia gap, and abscess appears in the area away from the lesion.
Abscess flow direction (30%)
(1) Cervical vertebrae: pus perforation of the periosteum and anterior longitudinal ligament, concentrated in the loose space between the long neck and the anterior cervical fascia, and the abscess of the fourth cervical vertebra is located in the posterior pharyngeal wall, called the pharynx Posterior wall abscess; the abscess of the 4th cervical vertebrae accumulates behind the esophagus, called the esophageal abscess. The huge posterior pharyngeal abscess affects breathing and swallowing. The patient has a loud snoring during nighttime sleep, and the abscess will spit out after being broken into the mouth or esophagus. Pus, cheese-like substance and dead bone, huge paravertebral abscess will protrude from one side of the neck to form a neck mass, which flows along the surface of the scalene muscle to the supraclavicular fossa, and the abscess of the lower cervical vertebra can be along The gap between the long neck muscles flows to one or both sides of the mediastinum, which is like a mediastinal tumor.
(2) thoracic vertebrae: mainly paraspinal abscess, prominent on both sides of the spine, usually asymmetrical in size, early abscess shape such as spherical, with the increase of pus and spread up and down, abscess shape like a fusiform, abscess in chronic cases It tends to be tubular and has calcification of the wall of the abscess. The paraspinal abscess can spread to the back through the transverse rib space of the rib. It can also flow along the intercostal vascular bundle to the distal end of the intercostal space. The abscess penetrates the pleura and becomes empyema.
(3) lumbar vertebrae: paravertebral abscess caused by lower thoracic and lumbar vertebrae, after perforating the periosteum, accumulate in the psoas muscle sheath, forming a psoas abscess, a shallow psoas abscess can cross the lumbar fascia to the waist triangle It becomes a lumbar triangle abscess. The lumbar triangle is a potential gap. Its edge is the posterior margin of the palate. The outer edge of the iliac spine muscle and the posterior margin of the oblique internal muscle. The psoas abscess can also flow along the psoas muscle. At the small trochanter of the femur, it becomes a deep abscess in the groin. It can also bypass the upper end of the femur, appear on the outside of the thigh, and even flow down the fascia to the lap.
(4) sacral vertebrae: the abscess accumulates into a anterior sacral abscess, which can be passed along the piriform muscle through the ischial hole to the buttocks, or through the fistula to the back of the humerus, or can be betted to the ischial rectal fossa and the anus.
(5) Caudal vertebra: appears as an anal abscess.
Prevention
Simple spinal tuberculosis prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Simple spinal tuberculosis complications Complications
Thoracic paraspinal swelling of the pus can be accompanied by empyema.
Symptom
Simple spinal tuberculosis symptoms Common symptoms Toxic skin, night sweats, high fever, low fever
1. The general symptoms are slow onset, low fever, fatigue, weight loss, night sweats, loss of appetite and anemia. Children often have nightingale, sluggishness or irritability.
2. Pain and pain are the first symptoms, usually mild pain. Symptoms are relieved after rest. After exertion, the symptoms are aggravated. Early pain will not affect sleep. Elderly patients will have pain at night.
3. Characteristics of cervical tuberculosis In addition to neck pain, cervical tuberculosis is also stimulated by nerve roots such as upper limb numbness, coughing, sneezing will cause pain and numbness, when nerve root is compressed, the pain is severe, if the pain is obvious, The patient often uses both hands to support the lower jaw, so that the head leans forward, the neck is shortened, the posture is very typical, the abscess of the posterior pharyngeal wall obstructs breathing and swallowing, the patient has a snoring sound during sleep, and the neck caused by cold abscess can be felt on the neck side at a later stage. Lump.
4. Characteristics of thoracic tuberculosis There is a symptom of back pain in thoracic tuberculosis. It must be noted that the pain of the lower thoracic vertebrae is sometimes manifested as lumbosacral pain. The kyphosis is very common, and the careless parents do not come to the hospital until they have a thoracic kyphosis.
5. Characteristics of lumbar tuberculosis When standing and walking, patients with lumbar tuberculosis often support the waist with both hands, tilting the head and trunk backwards, moving the center of gravity backwards, and minimizing the pressure on the diseased vertebral body. When the patient picks up objects from the ground, Can not bend over, you need to bend your knees and bend your hips to get the object, and the sample test is positive.
Another method of examination is that the child is lying prone. The examiner lifts the child's feet with both hands and gently lifts the lower limbs and the pelvis. If there is lumbar lesion, the waist remains stiff due to muscle spasm and the anterior vestibule disappears.
In the later stage, there is a psoas abscess formation. The abscess can be seen or touched in the lumbar triangle, the armpit or the groin. The lumbar spine tuberculosis is usually not severe, from the thoracic vertebrae to the tibia, along the sides of the iliac spine. Fingers can be touched in order, and mild kyphosis can also be detected. A few patients come to see a cold abscess.
Cold abscess will have high fever and severe symptoms of toxemia in the case of secondary infection. After the ulceration, a large amount of thin liquid will flow out first, mixed with cheese-like substance, and may also be accompanied by a small amount of dead bone. Road, long time unhealed.
Examine
Simple spinal tuberculosis examination
The rate of blood cell sedimentation increases.
X-ray inspection
(1) Bone and joint changes: X-ray films are mainly characterized by bone destruction and intervertebral space stenosis. Generally, there are no positive X-ray signs within 2 months after onset. Therefore, repeated examinations or other tests are required for suspicious cases. The central type of bone destruction is concentrated in the center of the vertebral body. The lateral slice is relatively clear, and the vertebral body is compressed into a wedge shape. The front is narrow and wide, and can also invade the intervertebral disc, involving adjacent vertebral bodies, and the edge type of bone destruction. Concentrated on the upper or lower edge of the vertebral body, quickly invading the intervertebral disc, manifested as destruction of the vertebral endplate and progressive intervertebral space stenosis, involving the adjacent two vertebral bodies, marginal bone destruction and wedge compression The center type is obvious, so the kyphosis is not heavy.
(2) Cold abscess: in the lateral radiograph of the cervical vertebrae, the soft tissue shadow of the anterior vertebrae is widened, the trachea is moved forward, and the soft tissue of the paravertebral widening is visible on the thoracic vertebrae. It can be spherical, fusiform or tubular, generally Asymmetry, the lumbar vertebrae abscess on the lumbar vertebrae is characterized by blurred shadow on one side of the psoas muscle, or widened shadow of the psoas muscle, full or localized bulge, and the abscess can even flow to the buttocks and the thigh triangle. Chronic cases can be seen with a large number of calcification shadows.
2. CT examination CT examination can clearly show the location of the lesion, showing the formation of cavities and dead bones, even small paravertebral abscess can be found in CT examination, CT examination has unique value for the detection of psoas abscess. .
3. MRI examination MRI examination has early diagnostic value, abnormal signal can be displayed in the inflammatory infiltration stage, and can also be used to observe the compression and degeneration of the spinal cord.
Diagnosis
Diagnosis and diagnosis of simple spinal tuberculosis
According to medical history, clinical manifestations, signs, X-ray films, CT, MRI and laboratory tests, clinical diagnosis is not difficult.
Differential diagnosis
1. Ankylosing spondylitis This disease occurs in men under 40 years old. It is more common in patients under the age of 20, and there is also low back pain and lumbar vertebrae. The blood cell sedimentation rate is increased, and it is easy to be confused with spinal tuberculosis, but this disease 100% have ankle inflammation, no symptoms of systemic poisoning, X-ray examination can not see bone destruction and dead bone, and the clinical manifestations of thoracic expansion limitation after thoracic spine involvement are sufficient to identify.
2. Suppurative spondylitis purulent spondylitis is acute, with high fever and obvious pain, rapid progress, early blood culture can detect pathogenic bacteria, X-ray performance progresses fast, and its characteristic X-ray performance can be identified.
3. Lumbar disc herniation lumbar disc herniation has no systemic symptoms, there are symptoms of lower limb nerve root compression, blood cell sedimentation rate is not fast, no bone destruction on X-ray film, CT examination can find prominent nucleus pulposus.
4. Spinal tumors Spinal tumors are more common in the elderly, and the pain is aggravated day by day. The bone destruction on the X-ray film involves the pedicle, the intervertebral space is normal, and there is no shadow of the paravertebral soft tissue.
5. Eosinophilic granuloma eosinophilic granuloma is more common in the thoracic vertebrae. The patient's age is usually less than 12 years old. The entire vertebral body is flattened into a line shape, and the upper and lower intervertebral space are completely normal. There is no systemic symptoms such as fever.
6. Degenerative spondyloarthropathy degenerative spondyloarthropathy is an senile disease with a narrow intervertebral space. The upper and lower margins of the adjacent vertebral body are hardened and white, with a bone bridge formed without bone destruction and systemic symptoms.
