Spondylitis

Spondylitis inflammation in the spine. Most often spondylitis (almost in 95% of cases) has tuberculosis etiology, much less meet staphylococcal, syphilis, positivity spondylitis, actinomycosis spine, chronic osteomyelitis of the vertebrae.

tuberculous spondylitis
Fig.1. The destruction of the vertebrae in tuberculous spondylitis.

Tuberculous spondylitis occurs mainly in children and frequency is one of the first places among all forms of osteoarticular tuberculosis (see). Currently, due to the wide control of tuberculosis absolute number of patients with tuberculous spondylitis is not large. TB infection gets into the vertebrae hematogenous route of primary TB infection focus more often in the lungs. Almost always begins in the body of the vertebra (bow and shoots are affected rarely), sponge-like material which has a rich blood supply. Included with the blood TB bacilli cause the formation of tuberculosis mound, and then, when it decays, specific necrotic lesion. Increasing in size, this focus destroys the cortical layer, then the intervertebral disc and moves to an adjacent vertebrae (Fig. 1)to include 2-3 or more vertebrae. More often tuberculous spondylitis is localized in niederroden and verkhnepashino spine.


Fig. 2 Gait with the defeat of the thoracic spine.
Fig. 3. Characteristic posture with the defeat of the cervical vertebrae.
Fig. 4. The lifting of the subject from the floor patients tuberculous spondylitis (limiting the mobility of the spine).
Fig. 5. The study limited the mobility of the spine.

The clinical picture of tuberculous spondylitis conditioned by the degree of defeat of the vertebrae and surrounding tissues. The earliest symptom of tuberculous spondylitis are a pain and limited mobility of the spine. Usually, the pain caused by compression of the roots of the spinal cord, are localized in the lower back and spine, but often the child complains of pain in the abdomen. Sick child becomes anxious, fatigued, sleep poorly. Gait changes, is careful, the child goes with straightened his back, thrusting forward his stomach (Fig. 2). Patient protects the spine and pain in any push, trying to reduce the load, constantly supporting his head with his hands (Fig. 3) when spondylitis cervical spine or resting his hands on her hips - spondylitis thoracic and lumbar regions. Limiting the mobility of the spine becomes clear if to offer the child to lift any object from the floor (Fig. 4). He does this, sitting down on his haunches with a completely straight back, resting a hand on his thigh. Limiting the mobility of the spine, characteristic spondylitis, is defined as follows (Fig. 5). Baby lay stomach down hard on the couch. Legs slowly lifted up, and his other hand at this time, carefully conducted along the spine. Such reception is determined muscle tension in the area affected vertebrae and limited mobility of the spinous processes. By pressing a finger been a clear local tenderness, and sometimes vastanie one of the spinous processes.
The destruction of the vertebral bodies is accompanied by their flatten and deformity of the spine in the form of a hump. Spinous process destroyed vertebra most sharply stands and is located on top of a hump-shaped angle. The presence of the hump is the most common symptom of tuberculous spondylitis, testifies about the destruction of the bodies of several vertebrae and indicates a far-reaching process. Spinal deformity in tuberculous spondylitis is accompanied by significant changes of the whole skeleton, especially the chest, often with dysfunction of internal organs.
At the neglected spondylitis symptoms lesions of the spinal cord and spinal nerves with the development of neuralgic pain and paralysis. Tuberculous process on the spinal cord passes extremely rare, more often the spinal cord squeezed destroyed vertebra or wandering abscess. Compression of the spinal cord with severe neurological symptoms are more common in spondylitis thoracic spine, where narrow spinal canal.
An important feature of tuberculous spondylitis are cold abscesses - atechnique (see). After the destruction of the vertebral body necrotic masses and pus in the interstitial spaces are distributed at a considerable distance from the primary tumor. Matecznik makes its way from tel shattered vertebrae in the interstitial spaces along the spine, iliopsoas muscle, coming out in Ilium, on the thigh, the lower back. Wandering the abscess is characterized by the appearance under the skin seals, and then and elastic protrusion, the skin over which initially not changed, but then, as a result of inflammatory processes spaevaet with him, abscess breaks out with the formation of a fistula through which stand out the pus and necrotic masses.
In the diagnosis of tuberculous spondylitis in the importance belongs to x-ray methods. X-rays taken in direct and lateral projections, allow early and clearly identify the lesion in the vertebra, and often the presence of matecznik. Of special x-ray techniques most valuable is tomography (see) and fistulography (see).
The forecast. Tuberculous spondylitis is a long period and requires long-term treatment in specialized institutions of sanatorium type. Early diagnosis and complex treatment with application of modern antibacterial drugs in combination with a restorative treatment in sanatoriums and surgical methods of treatment allow to receive persistent cure with good anatomic and functional results. Mortality in tuberculous spondylitis currently almost nonexistent.

  • Treatment of tuberculous spondylitis
  • Pyogenic spondylitis
  • Infectious spondylitis