Tuberculous spondylitis, its consequences and treatment methods

Spondylitis

is a disease of the spine of inflammatory etiology.
First of all, it affects the vertebral body, destroying it and reducing its height. In severe cases, a hump may form, ossification of the rib joints and displacement of internal organs. But this is not the only danger of spondylitis
.
In the long term, it leads to complications in the heart, liver, kidneys and nervous system. Both old and young are susceptible to the disease. The pathology is often observed in adolescents over the age of 15 years. Fortunately, spondylitis
is not very widespread - no more than 0.6% of people suffer from it.

But if the disease already exists, is it possible to avoid spinal deformation and worsening the condition? Let's understand the nature of spondylitis

.

Types of spondylitis

Depending on the causes of the disease, pathology is usually divided into:

• Specific spondylitis
  . This category includes diseases caused by a specific infectious pathogen. As a rule, these are spondylitis secondary to tuberculosis, syphilis, gonorrhea, typhoid fever, actinomycosis, brucellosis and other diseases.
• Nonspecific spondylitis
  .
  This group of spondylitis occurs as a result of nonspecific infections. They are caused by microorganisms that are already found in the human body or are considered only conditionally pathogenic. Therefore, spondylitis
  begins only after a “trigger” has been triggered - for example, injury, stress, hypothermia, hormonal imbalance.

Based on the location of the inflammatory focus, the following are distinguished:

• cervical spondylitis;
• thoracic spondylitis;
• spondylitis of the lumbar spine
  .

of spondylitis also varies

- it can progress slowly, with exacerbations, quickly and rapidly (within several hours - which is typical for septic spondylitis).

Tuberculous spondylitis

Tuberculous spondylitis

(Pott's disease) most often affects the thoracic region in children and adolescents because their musculoskeletal system is still developing. Bacteria (Koch's bacillus) penetrate the vertebral body and, releasing toxins, provoke a focal necrotic process in it. Over time, tuberculous spondylitis spreads to neighboring vertebrae, leading to the formation of edema and abscesses. Patients complain of increased fatigue, insomnia, and back pain.

Tuberculous spondylitis

may debut several months or even years after infection with tuberculosis - after stress, injury or decreased immunity.
The disease is characterized by a severe course, since it affects large areas at once. Also, the difficulty of treating tuberculous spondylitis
lies in the resistance of the pathogen to most antibiotics.

Aseptic spondylitis

Kümmel-Verneuil disease, also known as aseptic spondylitis

, begins with a back injury. Usually, several months or years pass between the injury and the onset of spondylitis - often patients even forget about the initial incident. However, after the appearance of necrotic lesions in the spine, their condition begins to worsen. Due to improperly distributed load, the risk of compression fractures of the spine and inflammatory processes in the nerve roots increases.

First of all, aseptic spondylitis affects the thoracic region, in rare cases it declares itself as lumbar spondylitis

. Young men under the age of 40-45 are most susceptible to it.

Ankylosing spondylitis

Ankylosing spondylitis

also known as ankylosing spondylitis. In this disease, the body's immune cells begin to attack its own bone and cartilage tissue, destroying the structure of the joint and the ligaments surrounding it. The body tries to compensate for the loss of tissue by replacing it with bone growths (osteophytes). Ultimately, this leads to ossification and complete immobility of the affected joint.

In addition to the loss of normal motor abilities of patients with ankylosing spondylitis

I am bothered by excruciating pains that do not subside even at night. When fusion of the vertebrae in the thoracic region occurs, difficulty breathing is observed, which can cause congestion in the lungs. Symptoms of the disease intensify after physical activity or prolonged rest.

90% of patients with ankylosing spondylitis

are made up of men.
The disease makes its debut between the ages of 15 and 40 years, and early onset often precedes its unfavorable course. Among patients with ankylosing spondylitis, lumbar spondylitis
.

Causes of spondylitis

Spondylitis of the spine

can be called a “disease of neglected infections” - most often it occurs as a complication due to late access to a doctor for the treatment of infectious diseases.

It can be caused by both a chronic infection circulating in the body (for example, streptococcus, Staphylococcus aureus, actinomycosis) and an acute infectious disease (for example, typhus, gonorrhea and even tonsillitis or pyoderma). The following factors can provoke the development of spondylitis against the background of an underlying infection:

• general suppression of the immune system due to an unhealthy lifestyle or bad habits;
• hormonal changes in the body or endocrine disorders;
• psycho-emotional or physical stress;
• spinal injuries;
• the presence of a focus of chronic infection;
• severe hypothermia or overheating;
• long-term use of medications (especially glucocorticoids and cytostatics);
• genetic predisposition (indicative if there have already been cases of spondylitis in the family).

Risk factors, causes

The greatest predisposition to the development of this pathology is noted among the following categories of people:

• people caught in the epidemic zone;
• those who have chronic diseases of internal organs and systems;
• population living in unfavorable conditions, especially if there are sanitary and hygienic violations;
• children and adolescents;
• patients suffering from endocrine system disorders;
• people who have undergone organ implantation surgery;
• patients undergoing hormonal therapy;
• people who have been diagnosed with a malignant neoplasm.

Consequences

If the necessary therapeutic measures are not applied to the identified disease, the following complications may occur::

• 
  The main complication of Pott's disease is disruption of the functioning of the spine; problems with the motor function of the spine;

• paralysis of the lower or upper limbs;
• bladder dysfunction;
• pathologies in the functioning of the large intestine;
• problems with reproductive function;
• tuberculous meningitis;
• breakthrough of the abscess and its penetration into the lumen of the spinal canal, leading to epiema (a complication that represents the accumulation of pus in any body cavity or inside organs).

Due to the risk of disease outcome, it is important to start therapy as early as possible to avoid the development of serious complications. If proper treatment of the disease is not carried out or started too late, there is a high risk of death .

Symptoms of spondylitis

Symptoms of spondylitis begin and intensify as bone density in the spine decreases. Therefore, at the initial stage (when only one vertebra is affected), the clinical picture of the disease may be blurry. The first signs of the disease include:

• moderate pain in the thoracic or sacral spine, which bothers the patient only periodically;
• general decrease in endurance;
• characteristic poses designed to reduce the load on the affected area.

Later, depending on the location and type of spondylitis, other alarming symptoms appear:

• feeling of suffocation and shortness of breath, difficulty taking deep breaths, pain in the sternum;
• spread of pain to other parts of the spine and its intensification;
• pain persists during rest;
• characteristic lumbago;
• instability of blood pressure, its sharp jumps;
• redness and increased temperature of the skin over the site of inflammation;
• swelling of the affected areas;
• abdominal pain (in particular, with lumbar spondylitis);
• deterioration in sleep quality;
• “gentle” gait;
• mood problems - depression, irritability, emotional “reactivity”.

At the last stage, irreversible changes appear:

• kyphosis caused by spinal deformation (as a rule, the natural curves of the back are disrupted, and the stomach protrudes forward);
• characteristic hump and shortening of the spinal column;
• immobility, stiffness of the back, which is especially noticeable when turning the body;
• numbness of the limbs and loss of ability to self-care;
• paralysis;
• disruption of the pelvic organs (including problems with the toilet);
• fistula formation is possible.

With the rapid progression of purulent spondylitis, symptoms develop within several hours and begin with acute pain and an increase in temperature to 40 degrees or more. There are also symptoms of acute intoxication - dizziness, severe weakness.

Symptoms and diagnostic methods

At the initial stages of the disease, symptoms may not appear, but over time the disease acquires a characteristic clinical picture.

The main signs of spinal tuberculosis are::

• Slight increase in body temperature (as the disease progresses, temperature readings will increase);
• Chronic fatigue, poor health;
• Decreased intellectual and physical ability to work;
• The appearance of painful sensations (in the last stages, pain occurs even at rest);
• Decreased functionality of the spine, curvature of the spinal column;
• A constant feeling of tension in the muscle tissue of the spine (the patient feels pain when exposed to it);
• Decreased sensitivity of the limbs, their further paralysis.

Diagnostics

To make a diagnosis, it is necessary to evaluate the totality of clinical manifestations of the disease, as well as conduct a number of instrumental studies. The most informative are chest x-ray and MRI of the spine .

X-ray examination can detect primary foci of tuberculosis infection, which are located in the lymph nodes of the chest, as well as in the upper parts of the lungs. This method also allows you to determine the duration of infection.

If the pathology is at an early stage of development, with the help of the study you can see a slight deformation of the vertebral bodies. If the infection occurred a long time ago, calcium deposits form in the lesions, which can be seen using x-rays.

MRI allows you to determine the presence of tuberculous abscesses that form in the affected area, assess the degree of vertebral deformation and curvature of the spinal column.

CT scan of the spine for tuberculosis

To obtain a more detailed picture of the development of the disease, other diagnostic methods are used, such as : ultrasound; ; histological examination of tissues of the affected area; biopsy.

Do you want to know what other infectious diseases of the spine exist?

• What are the symptoms of tuberculous spondylitis of the spine?
• How dangerous osteomyelitis of the spine is is described on the page
• To find out whether spinal cord myelitis can be completely cured, follow this link
• You can find out what an epidural abscess is in the following article.
• You can learn more about the treatment of spinal spondylodiscitis here
• Information about the clinical picture of spinal discitis can be found in the following article

Treatment of spondylitis

Treatment of spondylitis

consists in the complex use of medications, physiotherapy, diet therapy and therapeutic exercises. Surgical interventions to relieve symptoms are performed quite rarely - mainly for tuberculous and ankylosing spondylitis.

It is necessary to begin treatment for spondylitis when the first, still mildly expressed, pain in the sternum, neck or sacrum appears. The treatment strategy is selected taking into account the nature of the disease, the patient’s age, and the presence of neurological problems associated with compression of the spinal roots.

With proper and timely treatment, it is possible to avoid a reduction in life expectancy in patients with spondylitis.

Exercise therapy for spondylitis

Therapeutic exercises for spinal spondylitis are performed only in a state of remission, in the absence of the slightest symptoms of inflammation. With regular exercise, exercise therapy helps eliminate stiffness and spasms in the back, and increases the overall endurance of the muscles and ligaments that form the supporting corset for the spine. Also, therapeutic exercises help to unblock compressed nerve roots and improve blood circulation in the tissues of the spine. A set of exercise therapy exercises for spondylitis is compiled individually, after a complete examination of the patient. The fact is that even minor injuries with this disease can cause a compression fracture of the spine.

Diet for spondylitis

For patients with spinal spondylitis

It is recommended to avoid foods rich in starch and other simple carbohydrates, such as:

• potato;
• fast food;
• confectionery and baked goods, especially factory-made ones;
• White bread;
• sugar and carbonated drinks;
• coffee “3 in 1”;
• alcohol.

Sausages and refined fats (mayonnaise, margarine) are also extremely undesirable.

To combat anemia and inflammation, patients are advised to eat foods high in:

• iron (buckwheat, greens, pomegranate, liver);
• antioxidants - vitamins E, C, flavonoids (fruits, primarily red, berries);
• polyunsaturated fatty acids (sea fish, nuts, unrefined olive and flaxseed oil);
• calcium and boron (dairy products, beets, green peas, apricots).

To relieve intoxication and normal metabolism, you should drink at least 2 liters of water per day.

Physiotherapy

Physiotherapy plays a supporting role in the treatment of spondylitis

.
First of all, it is aimed at relieving the inflammatory process and cold swelling in the spine, healing necrotic lesions and fistulas. For spinal spondylitis,
the following methods are recommended:

• electrophoresis;
• laser therapy;
• ultrasound therapy;
• shock wave therapy;
• phonophoresis;
• balneotherapy (especially medicinal baths);
• massage (including hydromassage) and manual therapy;
• passive and active kinesiotherapy;
• high-tone bioresonance therapy;
• physiotherapy.

Medicinal phono- or electrophoresis with glucocorticosteroids, as well as magnetic therapy are used during exacerbation of spondylitis. Other methods are priority during the period of remission.

Surgery

Surgical methods for treating spinal compression fractures are necessary for complicated fractures. They can be using open surgical techniques or using minimally invasive techniques. Open surgeries are performed for severe trauma when bone fragments damage the spinal cord and spinal roots.

Minimally invasive methods are used more widely, since during surgery the damage to muscles and bones is insignificant, which reduces the risks of complications and allows the damaged bone to recover faster. The main methods are:

• vertebroplasty
• kyphoplasty

Drugs for spondylitis

Drug therapy is the main treatment for spondylitis. In addition to antibiotics to eliminate the underlying disease, nonsteroidal anti-inflammatory drugs (NSAIDs) are considered the leading drugs. They allow you to relieve the symptoms of inflammation, remove swelling and completely or partially eliminate pain. NSAIDs cannot be taken constantly - they are prescribed only during exacerbations, since they negatively affect the gastrointestinal mucosa.

For severe inflammation and extensive necrosis of spinal tissue, glucocorticoid steroids are prescribed. This group of drugs is also intended for short-term symptomatic use, since long-term use can only worsen spondylitis.

In case of infectious intoxication of the body, drip intravenous administration of solutions to remove toxins is indicated. To protect healthy tissues and improve metabolic processes, B vitamins, blood microcirculation correctors, and vasoprotectors are used.

Due to the fact that the affected spine cannot perform its supporting function in full, the back muscles take on part of the load. Constant overexertion causes severe spasms; to relieve them, patients are prescribed antispasmodics and muscle relaxants.

The only group of medications that really helps restore damaged tissues are chondroprotectors.
Chondroprotective agents for the treatment of spondylitis help accelerate regeneration processes in the spine, protect healthy cells from the adverse effects of toxins and enzymes, and also significantly slow down the progression of the disease. They are most effective in cases of slow or worsening disease, as well as in the recovery period after treatment of septic spondylitis. For spondylitis of various etiologies, doctors recommend a course of Artracam. It is enough to take this chondroprotector in a sachet for 2-4 months a year to prevent or slow down the transition of spondylitis to new joints. Artracam reduces pain, helps prolong remission, and most importantly, allows you to less frequently resort to taking anti-inflammatory drugs that are unsafe for health. Being a natural product based on glucosamine, Artracam has no contraindications for use at any age. And may spondylitis spare your joints!

Treatment

Therapy is carried out exclusively in specially equipped TB hospitals.

Provided that treatment is started on time, therapy can be very successful, especially in the early stages.

A long full course of therapy is protracted and can last from 6 months to several years.

A person with tuberculous spondylitis is considered contagious. To avoid infecting others, he should be placed in a TB department. He needs strict bed rest, long-term antibiotic therapy and exercise restrictions. .

Drugs

The following types of treatment are usually prescribed from medications::

• etiotropic therapy , in which several anti-tuberculosis drugs are used at once (Rifampicin, Ethambutol, Isoniazid, Streptomycin). The course of treatment can be 2-6 months;
• symptomatic therapy , which uses corticosteroids, muscle relaxants, non-steroidal drugs and B vitamins.

Surgery

Surgery can be used in cases where the effect of conservative therapy is not observed , and drainage of abscesses is required, and progression of neurological disorders is observed.

The operation may be scheduled after the acute phase has subsided in the first year of the disease. The operation consists of removing necrotic tissue. In this case, the vertebrae are replaced with prostheses and compression is eliminated. The spinal column must also be strengthened with plates and screws. An abscessectomy may be performed.

Exercise therapy and massage

Patients who have undergone surgery require long-term rehabilitation, during which wearing a plaster corset, physical therapy and physiotherapy are recommended.

Treatment at home

Patients suffering from this disease can benefit greatly from sanatorium treatment. It is important to properly organize your work and rest schedule, avoid excessive stress, spend more time in the fresh air, and stop smoking and drinking alcohol.

Pott's disease is treated in a hospital. Therefore, the use of folk remedies acts as an additional therapy. You need to carefully plan your diet. Meals should be taken at least 5 times a day. The diet should consist of high-calorie foods enriched with vitamins.

It is useful to drink the following drinks:

• freshly squeezed carrot and celery juice 100 ml before meals once a day;
• brewed rosehip;
• infusion of St. John's wort. It can be prepared by brewing 10 g of herbs with boiling water and leaving for a third of an hour. Then strain. Drink up to three times a day, a tablespoon before meals.

For this pathology, taking a mixture of walnuts and honey can be very effective. To prepare it, mix 3 tbsp. chopped nuts and one tablespoon of honey. Take twice a day, morning and evening.

Prevention

To avoid the development of complications with this disease, it is necessary:

• timely identification of its first signs and prescription of competent therapy;
• undergoing an annual examination, including fluorography;
• careful attention to personal hygiene;
• improving the quality of living conditions;
• educational work in the field of sanitary and hygienic standards.