Tuberculosis of the spine

Tuberculosis of the spine, or tuberculous spondylitis, is an inflammatory disease of the spine, the characteristic symptom 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 tuberculous spondylitis has increased sharply. They account for 70% of those admitted for surgical treatment. Men suffer from spinal tuberculosis more often than women, on average in a ratio of 55:45. In terms of localization of the lesion, the thoracic spine is in first place (60%), and the lumbar spine is in second place (30%). The frequency of lesions in the cervical and sacral spine 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 significantly. In newly diagnosed patients, lesions of 2-3 vertebrae are most often found (65%), destruction of the body of one vertebra is found in 1-3% of cases. Extensive destruction is most typical for the thoracic and thoracolumbar spine. In long-term patients, 10 or more vertebrae may be affected. Local damage to the posterior structures (arches, articular, spinous and transverse processes) is rare. In recent years, the number of patients with spinal tuberculosis in combination with active tuberculosis of the lungs, kidneys, eyes and other organs has increased.

Symptoms of spinal tuberculosis

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

• Stage I - primary tuberculous ostitis,
• Stage IIa - progressive spondyloarthritis without dysfunction:
• Stage IIb - progressive spondyloarthritis with functional impairment;
• Stage III - chronic destructive spondylitis with complete loss of function;
• Stage IV - post-tuberculosis spondyloarthrosis (a consequence of previous spondylitis).

Clinical cure is established in individuals who have received comprehensive, including surgical, treatment for spinal tuberculosis, in the absence of symptoms and laboratory signs of activity of a specific process, anatomical and functional disorders.

Residual changes are noted during spontaneous or clinical healing of a specific process with the formation of encapsulated bone foci of calcification and scars in soft tissues, not accompanied by pronounced anatomical and functional disorders and patient complaints.

The extent of the lesion is determined by the number of affected vertebrae. For the spine, this would look like this.

• Local (limited) lesions include tuberculous osteitis - a single lesion within one vertebra or a lesion within one spinal cord.
• Common lesions are those that are found in two or more adjacent PDS.
• Multiple lesions are lesions of two or more non-adjacent PDS.
• Combined forms include lesions of two or more organs belonging to different systems.

Localization of the lesion, the tuberculous process in the spinal column can be localized both in the anterior sections of the vertebrae (bodies, roots of the arches), and in the posterior ones - in the articular, transverse, spinous processes and arches of the vertebrae. The lesion of the posterior sections of the vertebrae is often called posterior spondylitis. According to the location of the affected vertebrae, the section of the spine and the number of the vertebra are indicated.

Complications of spinal tuberculosis

• 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, instability of the spine.
• Tuberculosis of the spine also has neurological complications: radicular syndrome, pyramidal insufficiency syndrome, paresis of varying depth, plegia, myelopathy, and dysfunction of the pelvic organs.

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