Spinal tuberculosis, T.V. Bolotnik Phthisiatrician at the anti-tuberculosis dispensary

At present, unfortunately, there is no tendency to reduce the incidence of tuberculosis among the population. Ukraine continues to be among the “top ratings” in terms of tuberculosis prevalence statistics.

Quite often we come across leaflets, posters or brochures explaining what pulmonary tuberculosis is. I want to talk a little about other manifestations of this disease in humans. For example, in large joints: hip, knee, shoulder , damage to which can go undiagnosed for a long time and be masked as external manifestations of arthrosis.

Tuberculous coxitis (tuberculosis of the hip joint)

According to statistics, the most common joint affected by tuberculosis is the hip joint.

Symptoms

Tuberculous coxitis is characterized by a long-term chronic course and periodic exacerbations. An exacerbation usually occurs when the intraosseous focus of tuberculosis breaks into the joint cavity. Patients may complain of low-grade fever, weakness, fatigue, and lameness. The pain can be in both the hip and knee joints, which naturally complicates diagnosis. During an exacerbation of the disease, swelling is observed in the joint area and enlarged lymph nodes can be felt.

Diagnostics

Most often, at the initial stages, classical X-ray diagnostics are used; it is better to use digital radiography. Using the image, bone atrophy, local, and later widespread osteoporosis can be diagnosed.

In cases where making a diagnosis may be difficult or simply requires a more detailed diagnosis and a 3-dimensional view of the lesion, spiral computed tomography (SCT) can be used.

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Bone tuberculosis

Bone tuberculosis is the most common form of tuberculosis after pulmonary tuberculosis. The disease can occur at any age, but most often affects adults. Tuberculosis occurs in various parts of the musculoskeletal system, but, as a rule, most often the pathological process develops in the spine.

Causes of bone tuberculosis

The development of the disease is facilitated by increased physical activity, injuries, recurring diseases, including infectious diseases, hypothermia, and unfavorable living and working conditions.

Previous contact with a patient with tuberculosis is crucial. The disease occurs when an infection - Mycobacterium tuberculosis - penetrates from a tuberculosis focus in the lungs through the blood and lymphatic vessels into the bones. Therefore, bone structures that have a good blood supply, such as the humerus, femur, vertebral bodies, bones of the lower leg and forearm, are at risk.

When mycobacteria multiply, specific granuloma tubercles are formed, which are then destroyed. When granulomas grow, the bone substance dissolves, abscesses (a cavity filled with pus), fistulas (a connection between the bone and the external environment that is not normally present, of inflammatory origin), and sequesters (a detached area of ​​dead bone) are formed.

With spinal tuberculosis, the disease usually begins in one vertebra. During the development of granuloma, the bone mass of the vertebra is destroyed, and the inflammatory process spreads to neighboring areas. The spine is deformed. When the thoracic spine is damaged, often due to compression of the spinal cord, paresis and paralysis are formed.

Possible symptoms of bone tuberculosis

At the onset of the disease, the characteristic manifestations of tuberculosis may be mild or absent altogether. Patients are concerned about a moderate increase in temperature up to 37°C, rarely higher. Children become lethargic, drowsy, adults complain of severe general weakness, irritability, nagging, aching muscle pain, and decreased performance. Some patients experience mild pain in the spine without a clear location after physical activity or at the end of the working day. After rest they disappear completely.

Thus, at the beginning of the disease, all manifestations are nonspecific, so most patients do not seek medical help, explaining these symptoms as banal fatigue.

You need to remember the following rule. If the pain does not go away after taking anti-inflammatory or painkillers, or the effect of the medication is insufficient or short-lived, then such pain is a sign of a serious illness that you most likely cannot cope with on your own.

When the tuberculosis process extends beyond the vertebra (in the case of spinal tuberculosis), the second phase of spinal tuberculosis begins. Weakness, lethargy, weakness intensify, high body temperature persists. At the same time, severe pain appears in one or another part of the spine. Due to pain, the patient tries to move less, and disturbances in gait and posture develop. At rest, the intensity of the pain either decreases or goes away completely. The muscles located along the spine are constantly in good shape, bulge, and are painful when touched.

In the third phase of spinal tuberculosis, the inflammatory process spreads to adjacent vertebrae. The general condition of the patients is serious. They lose significant weight, body temperature rises to 39-40 degrees, and severe general weakness persists. Pain in the spine is intense, often unbearable, and at rest its intensity decreases somewhat. Due to constant toning, the muscles along the spine atrophy, movements in the spine are severely difficult or impossible.

After treatment, patients are left with spinal deformity, back muscle atrophy, and limited mobility.

Some patients continue to complain of a feeling of instability in the spine and pain in the area of ​​the affected vertebrae.

The development of tuberculosis of the bones of the upper and lower extremities goes through the same stages as tuberculosis of the spine. Inflammation is accompanied by pain, redness of the skin and the development of swelling over the affected area. Due to bone destruction, limb deformation, gait disturbance, even lameness, and decreased ability to work occur.

Diagnosis of bone tuberculosis

All patients with suspected bone tuberculosis undergo radiography or tomography of the affected organ in two projections. In this case, foci of bone destruction, sequestra, and sometimes shadows from septic abscesses are identified.

In the presence of abscesses or fistulas, fistulography or abscessography is performed to determine their extent. The cavity of the abscess or fistula is filled with a contrast agent, then a series of images is taken. Microbiological examination of areas of dead bone, abscess contents or fistula tract is very important for making a diagnosis. The discovery of Mycobacterium tuberculosis speaks in favor of bone tuberculosis. A blood test determines all the signs of infectious inflammation: an increase in the number of leukocytes, accelerated ESR, the appearance of C-reactive protein, etc. To confirm the diagnosis, provocative tuberculin tests are also used.

Considering the secondary nature of the disease, if bone tuberculosis is suspected, it is always necessary to perform an x-ray of the chest organs, and if there are specific complaints, to conduct an examination of other organs.

Treatment of bone tuberculosis

Treatment for bone tuberculosis should be aimed at quickly eliminating the infection, preventing bone destruction, as well as nonspecific restorative treatment.

Diet for bone tuberculosis

During the active phase of inflammation, patients with tuberculosis experience increased protein breakdown. Therefore, for a speedy cure, it is necessary to increase the consumption of foods rich in protein. The amount of food consumed should be increased by 1/3. Daily caloric intake during the period of active inflammation averages 3100-3500 kcal per day. At the same time, super-enhanced nutrition leads to an overload of the body with unnecessary carbohydrates, obesity, and is therefore unacceptable.

A patient with tuberculosis should consume an average of 100-120 g of protein per day. At high body temperatures, protein intake is reduced to 70 g per day. Recommended: soups with meat or fish broth, meat in the form of cutlets, pate, boiled fish, a variety of egg dishes.

In case of tuberculosis during the recovery period, the content of milk and lactic acid products in the diet should be increased as a valuable source of calcium for the damaged bone. For inflammation, as well as during antibiotic treatment, it is recommended to consume large amounts of fresh fruits and vegetables, as well as medications containing a complex of essential vitamins.

Features of lifestyle during the treatment of bone tuberculosis

In case of active inflammatory process, bed rest is recommended. During the recovery process, physical therapy and massage can be used. The patient must spend as much time as possible in the fresh air; sunbathing has a good effect. As a rule, treatment and rehabilitation of such patients is carried out in specialized dispensaries and sanatoriums, where such a daily and rest regimen is observed.

Drug and surgical treatment of bone tuberculosis

The most effective treatment for bone tuberculosis is a combination of antibiotic therapy and surgical methods. Antibacterial drugs are used both before and after surgery. These are drugs such as rifampicin, isoniazid, pyrazinamide, ethambutol and others. As a rule, these drugs are used together for a long time according to a certain scheme.

The extent of surgical intervention depends on the degree of bone destruction, as well as the presence of abscesses and fistulas. Sequesters are surgically removed, abscess cavities and fistula tracts are washed with solutions of antiseptics and antibiotics. With adequate treatment, such cavities close on their own over time or are eliminated by a surgeon.

Much more complex operations are performed in the late period of the disease with the development of gross anatomical disorders and significant defects. Such operations do not eliminate the disability of patients, but can significantly reduce its severity.

Rehabilitation after recovery should be gradual. Its main task is to completely restore the function of the affected organ and return the patient to normal life. In this case, physical therapy, massage, physiotherapeutic treatment methods, as well as various methods of professional and social rehabilitation are used.

Possible complications of bone tuberculosis

Possible complications of bone tuberculosis include:

• rachiocampsis.

Severe curvature of the spine in bone tuberculosis

Severe curvature of the spine in bone tuberculosis

A hump often forms at the site of damage to the vertebrae. This is often combined with secondary deformation of the chest. In this case, compression of the chest organs is formed. With spinal deformation, all patients develop, to one degree or another, pronounced disorders of the nervous system, ranging from a slight increase in muscle tone or involuntary movements, ending with paresis and paralysis.

• abscesses in spinal tuberculosis are located next to the affected vertebrae. Can be of great length. The only treatment method is surgical.

• fistulas occur when the inflammatory process reaches the surface of the skin. Currently rare.

Prognosis for the development of bone tuberculosis

Currently, the mortality rate from bone tuberculosis is close to zero. But this disease is characterized by a very severe course with the development of irreversible bone deformations, which leads to permanent disability. It has been established that patients become disabled in half of the cases of spinal tuberculosis. Treatment is long-term, many drugs are toxic, but only timely seeking medical help and strict adherence to medical prescriptions will prevent irreversible changes.

Prevention of bone tuberculosis

General preventive measures include actions aimed at reducing the likelihood of encountering tuberculosis patients, as well as preventing hypothermia, injury, and intoxication.

Children and adolescents are recommended not to refuse routine tuberculin tests, as this can help in identifying hidden forms of the disease. Seeking medical help when pain in bones or muscles occurs helps to recognize the disease in the early stages and effectively treat it.

• Back
• Forward

Tuberculosis drives (tuberculosis of the knee joint)

The knee joint is immediately behind the hip joint in terms of incidence according to observations.

Symptoms

There is also a temperature of about 37 degrees, fatigue, lameness, pain that increases during loads on the leg, thickening of the skin fold, swelling of the joint, and limitation of its function. A fistulous tract may even form behind the joint, in the popliteal fossa.

Diagnostics

When using classical x-rays, it is also possible to observe atrophy of the bones that form the knee joint, and uneven osteoporosis can be determined. A detailed study can reveal a lesion in the bone that grows towards the joint, followed by destruction of the articular surface.

The use of SCT immediately answers many questions of interest: the exact number of lesions, their size, structure and content, the presence of small lesions not visible on x-rays, a 3D view of the location of lesions in the bones around the joint.

general information

Tuberculosis of the bones of the spine is an infectious process that occurs in one or several places at once. It develops when Koch's bacillus gets into the tissue. Several months pass from the onset of development to the appearance of the first symptoms. This is one of the most common forms of osteoarticular tuberculosis. It occurs mainly in men, but it is often diagnosed in women.

The disease affects the thoracic region in 60% of cases, the lumbar region in 30%, and the cervical and sacral region in 5%. The process can spread either to one vertebra or to several at once. Most often, two or more segments are involved. The bone form is often combined with other forms of tuberculosis in the body.

Prevention

In order to protect yourself from a dangerous disease, you need to:

• Avoid contact with sick people, do not use their things;
• Strengthen immunity;
• Create acceptable living conditions, take care of the cleanliness of the house;
• Undergo routine medical examinations (in particular, once a year it is necessary to do fluorography);
• Receive timely vaccination against tuberculosis.

Pay attention to how you can strengthen your immune system

Diagnostics

A child with suspected chronic inflammatory damage to bones and joints must be examined by a phthisiatrician.

A diagnostic examination for suspected tuberculosis must include:

• collection of complaints and anamnesis, including epidemiological;
• R-graphy of the OGK and all affected joints;
• UAC, OAM;
• proteinogram and blood test;
• latest data from the Mantoux reaction;
• bacterioscopic and bacteriological examination of biomaterial (sputum, urine, contents of fistulas and abscesses);
• CT, MRI.

Drawing up an examination plan

Causes

Spinal tuberculosis as a chronic infectious-inflammatory process develops in the body after the penetration of mycobacteria. The pathogen is able to “sleep” for a long time and retain its properties in the external environment, and become active only when it finds itself in conditions favorable for this.

Contributing factors for the development of the disease include:

• Contact with a person suffering from any form of tuberculosis.
• Received back injuries, open fractures.
• Poor nutrition, frequent hunger strikes or chronic malnutrition.
• Excessive exposure to physical or emotional stress.
• Frequent hypothermia of the back.
• Smoking, drug addiction or drinking alcohol.
• Weakened immunity.
• Poor living conditions.

A person becomes infected through direct contact, through the digestive system, by airborne droplets or in utero. At risk are people suffering from diabetes or chronic diseases of internal organs.

There is a high probability of developing tuberculosis in adults due to weakened immunity. It is he who prevents pathogenic bacteria from growing in tissues after entering the body. A decrease in defenses is the main factor contributing to the pathological process.

An X-ray allows for early detection of the presence of bone tuberculosis.

Principles of treatment

Therapy for the disease should be comprehensive and include:

1. Long-term use of antibacterial drugs (antibiotics effective against the pathogen TBS) according to standard regimens.
2. According to indications - surgical intervention, which is performed to remove necrotic tissue, restore joint function, etc.
3. During the acute period of the disease - wearing plaster casts, corsets, splints in order to unload the affected joints.
4. Spa treatment.
5. Exercise therapy.
6. Massage.
7. Physiotherapy.

A popular area of ​​reconstructive surgery is endoprosthetics

Damage to the child's bones and joints is accompanied by extensive destruction. If tuberculosis is not diagnosed and treated promptly, it can lead to early and severe disability. Be attentive to the health of the baby, because the cost of delay can be very high.

Preventive actions

Preventing the development of a disease is much easier than treating it. Therefore, it is recommended to minimize the likelihood of infection with Koch’s bacillus. To do this, it is necessary to regularly carry out preventive measures, one of which is vaccination. BCG vaccination is done in childhood, after which diagnostic measures are carried out aimed at monitoring the formation of immunity to mycobacteria (Mantoux test).

Prevention of tuberculosis includes strengthening the immune system through a healthy lifestyle, good nutrition, and exercise. All this helps prevent the development of the disease or its severe consequences. Relatives of tuberculosis patients are required to undergo chemotherapy courses as measures aimed at preventing the onset of pathology.

Spinal tuberculosis is a dangerous disease that develops in bone structures. Its insidiousness lies in the absence of characteristic symptoms, which does not allow starting treatment in the early stages. It is widely found in both adults and children, and without complex therapy, the pathology can lead to serious consequences, including disability.

Diagnostic procedures

Diagnosing tuberculosis is a complex process, because to identify a pathological process, the presence of several pronounced symptoms is not enough. The doctor prescribes a series of instrumental and hardware studies to confirm the presence of changes in the bone structure, abscesses or narrowing of the spinal canal. Typically the following methods are used:

• Radiography.
• Ultrasonography.
• Computer or magnetic resonance imaging.
• Biopsy.
• Polymerase chain reaction.

X-ray is the main diagnostic method to detect any changes in bone tissue. In addition, laboratory tests are prescribed, such as Diaskintest or Mantoux test. The results obtained make it possible to detect even minor changes with high accuracy and prescribe the correct therapy to the patient.

In adolescents and children, the diagnosis is often controversial and additional studies are required to exclude Calve or Scheuermann-Mau disease. Sometimes tuberculosis can be confused with congenital malformations, tumor metastases in another location, or a malignant tumor. All this requires additional differential diagnosis.

It is clear how tuberculosis develops in bone structures