Pathology of spinal tuberculosis

2021-01-26 12:00 AM

After several months of progression, damage to the vertebrae and numerous discs causes deformation of the spine, abscesses, and signs of compression.

Outline

The disease was first described in the late 19th century by an English surgeon named Percival Pott, so it is also known as Pott's disease.

Most often, after pulmonary tuberculosis, TB bacteria reach the spine via the bloodstream.

Also common in developing countries, the disease accounts for about two-thirds of tuberculosis cases. In the city orthopaedic trauma centre. In 1998, in HCM, there were 191 cases of tuberculosis, of which spinal tuberculosis accounted for 67.02%.

Usually 20-40 years old, men and women are equally affected.

Lesions in the lumbar and lumbar sections account for more than 90% (from lumbar 8 to lumbar 2).

Symptom

Onset stage

The primary hallmark is pain:

Pain in place: Pain in the affected spine area, fixed in an unchanged position. Pain continuously throughout the day and night, increased with exercise, walking, decreased during rest; less effective pain relievers.

Root-type pain: Due to compression of some branches of the nerve roots, pain spreading along the path of roots and nerves, in the neck to the shoulders and nape, in the back along the intercostal nerve, in the lumbar back spread along the sciatic nerve. Pain increases with coughing, sneezing and squeezing.

Examination:

Spine: Seeing a stiff spine, limiting movements that do not stretch when bending. The muscles on the sides of the spine can contract, knock on the posterior spine area of ​​the lesion to see pain clearly.

Systemic: Can see signs of TB infection, with combined TB lesions in> 50% of cases (lungs, pleura, lymph nodes ...).

X-rays and tests:

X-ray: Very important for diagnosis.

The disc is narrow compared to other segments.

The vertebral body is blurred, blurred in the anterior and upper face.

Softness around the vertebrae is darker.

For early detection of lesions, it is necessary to take tomography and density tomography.

Test:

Complete blood count: Lymphocytes increase.

The rate of blood sedimentation increases in 95% of cases.

The tuberculosis endoderm reaction (IDR) was positive in 90% of cases.

Inserting a needle next to the suction spine for testing: can find bacillus tuberculosis (BK).

Search for lung lesions in coordination: lung scan, find BK in sputum, a biopsy of lymph nodes.

Full-shot rounds

After several months of progression, damage to the vertebrae and numerous discs causes deformation of the spine, abscesses, and signs of compression.

Clinical:

Functional: Fixed, persistent pain, with frequent and pronounced nerve root syndrome.

Examination:

Convex vertebrae: A posterior protrusion of vertebrae can be seen on aside. Use your finger to gently brush along the back spines from bottom to top to see this clearly.

Cold abscess: Has a different location depending on the location of damage:

Cervical spine: The abscess bag goes straight to the back of the throat, visible when examining the throat, or descends along with the muscles next to the neck to the maxillary groin.

Spine: The posterior abscess bag can be raised just below the skin.

Lumbar spine: abscess just below the skin of the lumbar region, the buttocks area or comes forward down the groin, sometimes down to the hamstrings.

Cold abscesses are usually soft, painless, and some may rupture with a yellowish discharge and residue

the beans leave persistent sores and pores that don't heal.

Compression syndrome: is the worst consequence of the disease, due to much destruction of the vertebra and disc, displacement, subsidence and a tendency to slide backwards and compress into the marrow, horsetail. Depending on the location of the lesion, the patient has the following signs:

Paralysis of limbs: Damage to the neck.

Paralysis of 2 legs: Damage to the back, upper lumbar.

Horsetail Syndrome: Damage to the lower lumbar segment.

The degree ranges from sensory disturbance, decreased muscle tone to severe degree of spasticity, sphincter disorder.

Systemic signs: thinness, cachexia, fever, butt ulcers may occur due to lying long. TB lesions spread to other organs such as the lungs, pleura, and lymph nodes.

X-rays and tests:

X-ray:

The disc is almost completely destroyed.

The vertebral body is much destroyed, especially the front part creates a wedge-shaped, displaced backslide.

Image of cold abscess: on straight film there is a blurred image around the lesion, which may be uneven, with darker calcification.

Testing:

Increased blood sedimentation rate.

Piercing a needle next to the spine is more likely to find typical TB lesions.

Cerebrospinal fluid to diagnose spinal cord compression and spinal meningitis.

Final phase

Untreated or weakened body: progressive illness, severe paralysis, superinfection, TB spread to other parts such as tuberculosis of meningitis, tuberculosis of the heart, pleura and death of exhaustion.

Diagnose

Implementing the quadrants

Based on clinical and radiological symptoms. For early diagnosis, tomography and edge aspiration are required. During the full development period, diagnosis is easy because of all the signs, especially X-ray.

Differential diagnosis

Purulent bacterial spondylitis (Example: staph): Severe infection sign, onset condition (boils, juniors), radiograph without cold abscess.

Tumour lesions: cancer, metastasis, haemangioma ... based on systemic signs, X-ray does not show cold abscess. If in doubt, perform aspiration to confirm the diagnosis.

Treatment

Currently, it is mainly medical treatment with anti-TB drugs combined with rehabilitation. Immobilization and surgery are only indicated for certain cases.

Medical

Take anti-TB drugs according to the following principles:

Get treatment as soon as possible.

Coordinate at least 3 anti-tuberculosis drugs: Rimifon, Streptomycin, Pyrazinamide, Ethambutol, Rifampicin for 3 months, then reduce one type and continue taking the drug for 6-12 months.

Note the issue of drug resistance in East Asia.

Should take the drug once a day, morning, on an empty stomach.

Monitoring of systemic status, local lesions, side effects of drugs.

Follow a reasonable diet and rest.

Rehabilitation

Gently massage the muscles together with core exercise to avoid atrophy of stiff muscles.

After the pain is gone, all signs of inflammation begin to slowly and gradually increase your spine.

The problem of immobility

In the past, when there was no specific drug, treatment was mostly immobilized from 6 months to 1 year. Currently real estate is selective, depending on the case period from 3 to 6 months.

Motionless during progression, but incomplete, intermittent. It is best to use a powder bed so that the patient can change positions several times a day, to avoid muscle atrophy stiffness.

In case of serious injury to the spine with deviations that threaten compression, a cast is required.

The lesions are mild, diagnosed and treated early without immobilization with a cast.

Surgery

Indicated in the following cases:

Spinal tuberculosis is at risk of squeezing the marrow or squeezing it.

Tuberculosis has cold abscesses in place or travels far away.

Follow

Every month in the first year, every 3 months in the second year and every 6 months in the following years:

Side effects of the drug: clinical, biological.

The efficacy of anti-TB drugs is assessed clinically and radiographically every 2 months.

Criteria to evaluate healing:

The pain is gone.

Good overall condition.

Re-establish the ability to work, study.

No more pus, abscesses.

Bone regeneration is seen on radiographs.

Treatment failure

After 4 months of treatment, clinical and radiological symptoms persisted. The cause of failure is:

Primary drug resistance.

Lack of patient cooperation.

Using the wrong medication.

Poor organization of treatment, poor treatment control:

No clinical examination.

The drug does not have enough dose.

Insufficient treatment time.

Medicines provided unevenly.

Do not explain thoroughly to the patient.

Lack of regular medical follow-up.

Lack of monitoring of patients were discontinued.

There was a side effect of the drug that went undetected.