Tuberculosis of the spine

Tuberculosis of the spine, or tubercular spondylitis is an inflammatory disease of the spine, a characteristic feature of which is the primary destruction of the vertebral bodies with subsequent deformation of the spine.

Tuberculous spondylitis ranks first among all localizations of osteoarticular tuberculosis, accounting for 50-60% of the total number of patients. Recently, the number of adults with newly diagnosed tuberculosis spondylitis has sharply increased. They account for 70% of those admitted for surgical treatment. Men suffer from tuberculosis of the spine more often than women, on average, in a ratio of 55:45. The localization of the lesion in the first place is thoracic (60%), on the second - the lumbar (30%) department of the spine. The incidence of cervical and sacral lesions is 5% each. Double and triple localizations of lesions were previously rare, but now their frequency has increased and is about 10% in adults. The number of affected vertebrae varies considerably. In newly diagnosed patients, 2-3 vertebrae lesions are most often detected (65%), the destruction of the body of one vertebra is met in 1-3% of cases. Extensive destruction is most typical for the thoracic and chest-lumbar spine. In long-term patients, 10 or more vertebrae can be affected. Local lesion of posterior structures (arches, articular, spinous and transverse processes) is rarely observed. In recent years, the number of patients with spinal tuberculosis has increased in combination with active tuberculosis of the lungs, kidneys, eyes and other organs.

Symptoms of tuberculosis of the spine

Tuberculosis of the spine (tuberculosis spondylitis), depending on the nature of the active process, is divided into V stages:

• I stage - primary tubercular osteitis,
• IIa stage - progressive spondylitis without disruption of function:
• IIb stage - progressive spondylitis with impaired function;
• III stage - chronic destructive spondylitis with complete loss of function;
• Stage IV - post-tuberculosis spondylarthrosis (after spondylitis).

Clinical cure is established in persons who have received complex, including surgical, treatment of spinal tuberculosis, in the absence of symptoms and laboratory signs of specific activity, anatomical and functional disorders.

Residual changes can be ascertained by spontaneous or clinical cure of a specific process with the formation of encapsulated bones of calcifications and scars in soft tissues that are not accompanied by severe anatomical and functional disorders and complaints of patients.

The prevalence of the lesion is determined by the number of affected vertebrae. Applied to the spine, this will look like this.

• To the local (limited) defeat include tubercular osteitis - a single focus within one vertebra or lesion within the same PDS.
• Common defeats are those defined in two or more contiguous PDS.
• Multiple lesions are two or more of the non-adjacent PDS.
• Combined forms include the lesions of two or more organs belonging to different systems.

The localization of the lesion, tubercular process in the spinal column can be localized both in the anterior parts of the vertebrae (the body, the roots of the arches), and the posterior ones in the articular, transverse, spinous processes and arcs of the vertebrae. The defeat of the posterior parts of the vertebrae is often called posterior spondylitis. According to the location of the affected vertebrae, the spine department and the vertebra number are indicated.

Complications of tuberculosis of the spine

• General complications of tuberculosis (toxic-allergic lesions, amyloidosis, secondary immunodeficiency, etc.).
• Local inflammatory complications of spinal tuberculosis: abscesses, fistulas.
• Orthopedic complications of spinal tuberculosis: deformities, spinal instability.
• Tuberculosis of the spine also has neurological complications: radicular syndrome, pyramidal insufficiency syndrome, paresis of various depths, plegia, myelopathy, dysfunction of pelvic organs.

[1], [2], [3], [4], [5]