Tuberculosis Study Guide - M.M. Savula 2002

Extrapulmonary tuberculosis
Bone and joint tuberculosis
Spinal tuberculosis (tuberculous spondylitis)

Spinal tuberculosis is more commonly diagnosed in children, although it also occurs in adults. In children, the thoracic spine is predominantly affected, whereas in adults, the thoracolumbar region is most common, and the cervical or sacral regions are less frequently involved. The primary focus (primary osteitis) is located in the vertebral body, close to the intervertebral disc. In this phase, patients exhibit vague symptoms of systemic intoxication; there is no pain, but children avoid sudden movements and prefer to sit. Only tomographic imaging could detect the area of destruction in the vertebral body.

As the process spreads to the intervertebral disc and beyond the vertebra, pain arises. Initially, it lacks clear localization and is often misdiagnosed as radiculitis or intercostal neuralgia. Tenderness is noted upon Palpation of the spinous process of the affected vertebra. Subsequently, the pain intensifies and becomes localized, and spinal mobility is restricted. In Tuberculosis of the thoracic or lumbar spine, to pick up an object from the floor, the patient squats, resting their hands on their knees (Fig. 25). When the thoracic spine is affected, reflex tension of the back Muscles develops, appearing as oblique bands extending from the scapulae to the corresponding part of the spine (the "rein" sign) (Fig. 26).

Gradually, a spinal deformity develops, starting as a slight protrusion of the spinous process, followed by a gibbus (hump); to balance the trunk, the cervical and lumbar spine compensatorily curve forward (lordosis).

The destruction of several adjacent vertebrae leads to nerve ROOT compression and radiating pain. In cases of cervical spine involvement, patients experience pain in the occiput, arms, and fingers. Thoracic vertebral involvement causes pain in the chest, abdomen, and lower back. When the lumbar and sacral spine are affected, the pain radiates along the course of the sciatic nerve.

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Fig. 25. Early signs of spinal involvement in children - pain and functional impairment:

a - in cervical spine involvement, the patient tilts the neck and Supports the HEAD with their hands; b - in thoracolumbar involvement, walks leaning backward ("proud gait"); c - stands resting on the thighs; d - when picking up an object from the floor, squats without bending the back (after P.G. Kornev).

When the process extends beyond the affected vertebrae, cold abscesses develop, tracking down along the sides of the spine, into the lesser pelvis, or onto the thigh. Compression of the Spinal Cord by bone fragments or a cold abscess leads to paresis or paralysis, as well as pelvic organ dysfunction.

Radiographically, this stage reveals narrowing of the intervertebral space and destruction of the adjacent vertebral bodies. The intervertebral discs are destroyed, and the radiograph shows the partially destroyed body of one vertebra wedging into the vertebral body below, causing a spinal deformity (gibbus). Shadows of cold abscesses are often visible along the sides of the spine, below the affected area.

When the tuberculous process spreads beyond the vertebral body, a Diagnosis of progressive spondylitis is made, and in cases of a prolonged, fluctuating, and progressive course, chronic destructive spondylitis is diagnosed. The final phase of the disease is metatuberculous spondylopathy. In this phase, the specific process is relatively stable, but spinal deformities (gibbus), functional impairments, and paresis persist.

Fig. 26. Kornev's "rein" sign in Tuberculous Spondylitis of the mid-thoracic region.