Spinal tuberculosis complicated by paraplegia
Introduction
Brief introduction of paraplegic spinal tuberculosis The incidence of spinal tuberculosis combined with sputum is about 10%. The most common paraplegia is found in thoracic tuberculosis. The cervical vertebrae tuberculosis is followed by quadriplegia. The lumbar spinal canal is wide and the content is ponytail. Therefore, lumbar vertebrae tuberculosis complicated with cauda equina is affected. The pressure is extremely rare, and the spine attachment tuberculosis is rare. Once the disease occurs, paraplegia is prone to occur. basic knowledge The proportion of the disease: the incidence of the disease is about 0.0005%-0.0007% Susceptible people: no specific people Mode of infection: non-infectious Complications: cervical tuberculosis
Cause
Paraplegic spinal tuberculosis
(1) Causes of the disease
As the spinal tuberculosis destroys the vertebral body, the vertebral body is compressed, pus, tuberculous granulation tissue, cheese-like necrotic material and dead bone enter the spinal canal, compressing the spinal cord and causing paralysis.
(two) pathogenesis
Paraplegia complicated by spinal tuberculosis can be divided into early sputum and late onset sputum. Early sputum occurs in the active period of the lesion. In this period, pus, tuberculous granulation tissue, caseous necrotic material and dead bone enter the spinal canal, compressing the spinal cord If the oppressive substance is removed in time, the paraplegia can be completely restored; sometimes, the pus enters the anterior half of the spinal canal, causing embolization of the spinal artery, resulting in permanent damage to the spinal cord.
Delayed spasm occurs in the late stage of the lesion, even after healing for many years. The cause of caries is mainly due to the formation of bad compression of the spinal cord by the scar tissue. Most patients with hemorrhoids after healing for many years have kyphosis or staleness. Pathological fracture dislocation, the formation of osteophytes in front of the spinal canal is the main cause of compression, delayed onset of sputum can also originate from the embolization of spinal cord blood vessels (Table 1).
Prevention
Paraplegia prevention of spinal tuberculosis
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
Paraplegic spinal tuberculosis complications Complications cervical tuberculosis
Cervical tuberculosis is often complicated by quadriplegia, and thoracic tuberculosis causes both lower extremities.
Symptom
Paraplegic spinal tuberculosis symptoms common symptoms paraplegic spinal cord compression trembling spinal shock bloating dysfunction dysfunction constipation
In addition to the systemic symptoms and local manifestations of spinal tuberculosis, there is also the clinical manifestation of spinal cord compression. The banding sensation first appears. The band-like sensation is consistent with the lesion segment, which is the result of nerve root stimulation. The earliest dyskinesia, followed by sensory disturbance, the most late appearance of dysfunction of the bowel and vertebral, taking the thoracic tuberculosis as an example, usually slow onset, first felt that the lower limbs are weak, it is very laborious when going uphill, usually walking has the feeling of stepping on the quilt, then It was found that the walking was stiff, trembling and weak, and it was easy to stumble. Finally, the scissors step was taken, and it was in a state of paralysis. It was necessary to use crutches to assist walking, until bedridden or wheelchair-dependent life, and a large amount of pus poured into the spinal canal to produce an acute spinal cord. The person under pressure is characterized by flaccid paralysis of the lower limbs caused by spinal shock. After the shock has passed, it still develops into spastic paralysis. In cases of cervical tuberculosis, there are upper limb movement disorders, which can be tested and segmented during the examination. Consistent sensory loss plane, urinary dysfunction in the dysfunction of the bowel movement, initially urinary retention, there is urine, but Can not be discharged; reflex bladder function after recovery, the performance of urinary incontinence, bowel dysfunction are relatively light, bloating and constipation, fecal incontinence are rare, each case should be given to scores of paraplegia index standards.
Examine
Paraplegia check of spinal tuberculosis
Erythrocyte sedimentation rate increased.
CT and MRI examinations can show the location of the lesion, under pressure, and abnormal signals caused by liquefaction of the spinal cord can be observed on the MRI sheet to help estimate the prognosis.
Diagnosis
Diagnostic identification of spinal tuberculosis with paraplegia
According to the medical history, systemic symptoms, local manifestations, X-ray, CT, MRI examination, the diagnosis is not difficult.
