Vertebral tuberculosis

Introduction Spinal tuberculosis is the most common clinical, accounting for the first place in the body of bone and joint tuberculosis. 99% is vertebral tuberculosis. Vertebral tuberculosis accounts for about 50% to 75% of all patients with bone and joint tuberculosis.

Cause

Lumbar vertebrae in vertebral tuberculosis are most common, followed by thoracic vertebrae, followed by thoracolumbar spine, lumbosacral spine, cervical vertebrae, and the appendix bone is the least common. This is related to the vertebral body being heavy, easy to strain, less muscle adhesion and poor blood supply.

an examination

Related inspection

Mycobacterium tuberculosis antigen, antibody test plasma cell membranous effusion protein plasma cytoplasmic effusion glucometer

Vertebral tuberculosis can be divided into three types according to the original lesion site:

(1) Central type: The lesion is located in the center of the vertebral body and is found in children. It is characterized by bone destruction and the vertebral body is pressed into a wedge shape. Adults can be confined to the center of the vertebral body for a long time, and there is a dead bone. After the dead bone is absorbed, a cavity may appear.

(B) edge type: more common in adults, further involving adjacent vertebral bodies. Mainly due to osteolytic destruction, rarely dead bones, easy to invade the intervertebral disc, causing narrowing of the intervertebral space.

(3) Subperiosteal type: As the pus spreads up and down along the anterior longitudinal ligament, the anterior side of the adjacent vertebral body is corroded by the subperiosteal abscess for a long time, which is mostly secondary, and can involve several vertebral body leading edges at the same time.

Vertebral tuberculosis often forms a cold abscess, which spreads along the periosteum of the vertebral body to form a wide paraspinal abscess, and then forms a flow abscess away from the disease side.

MRI manifests as bone destruction at the edge of the vertebral body, often involving the upper and lower edges of adjacent vertebral bodies. Different degrees of edema area can be seen around the destruction area, showing T1WI low signal, T2WI and other high signal, and the intervertebral space is narrowed;

CT performance is:

(1) spots, spots, caves or honeycomb bone destruction;

(2) increased vertebral bone density;

(3) disc damage;

(4) formation of dead bones;

(5) paravertebral abscess, which often has calcification;

(6) osseous spinal stenosis;

(7) Changes in vertebral compression.

Differential diagnosis

Different vertebral tuberculosis has different ways of spreading.

Cervical vertebra: often located behind the long neck muscle. The upper cervical vertebrae form a posterior pharyngeal abscess and the lower cervical vertebra forms an abscess after the esophagus.

Thoracic vertebrae: often formed paravertebral abscess, the orthotopic X-ray film is spherical, with large tension, or cylindrical, fusiform. Paravertebral abscess can be injected into the back through the intercostal space of the rib or along the intercostal blood vessels to the distal end of the rib.

Lumbar vertebrae: often formed a flow of abscess, and more along the psoas muscle fascia to form a psoas abscess. The psoas muscle abscess can spread to the vicinity of the axillary, femoral or femoral trochanter due to gravity. It can also bypass the posterior side of the upper femur to the outside of the thigh, and then flow down the fascia to the vicinity of the knee joint. Deep pus in the psoas muscle can pass through the lumbar fascia and appear in the lumbar triangle.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.