As the disease progresses, the area of infection gradually enlarges and spreads to involve two or more adjacent vertebrae by extension beneath the anterior longitudinal ligament or directly across the intervertebral disc. This part of spine follows lumbar spine and is present in pelvic area. On examination, the spine is stiff and painful on movement. Neural Deficit The compression of neural structures leads to signs of neural deficit. A history of contact with known case of tuberculosis or recent visit to endemic area should be asked. The severity of the deformity depends upon the extent of destruction, the level of the lesion, and the number of vertebrae involved. Eventually the fibrous tissue is ossified, with resulting bony ankylosis of the collapsed vertebrae. It occurs most often in the mid-or upper-thoracic region, where the kyphosis is most acute, the spinal canal is narrow, and the spinal cord is relatively large.
Neural deficit in TB spine occurs due to pressure on the tissues of the cord, as follows. Another term used is caries spine or spinal caries. Extradural Mass formed by tubercular abscess [fluid pus, granulation tissue or caseous material. His steps are short, as he is trying to avoid any jarring of his back. Several of these symptoms and sign may be absent even in cases of active vertebral disease. But with improved public health measures, this age incidence has changed, and adults are more frequently affected. In the lumbar area it is less because of the normal lumbar lordosis becasue of which the body weight is transmitted posteriorly and collapse is partial. The neural foramen is the opening where the nerve roots exit the spine and travel to the rest of the body. The focus of infection usually begins in the cancellous bone of the vertebral body. In spite of vast spectrum of the disease, the early cases may not have any clinical finding except for tenderness in the region of the complaint. When the lesion is situated in the cervical or lumbar spine, a flattening of the normal lordosis is the initial finding. Muscle spasm makes the back rigid. This part of spine follows lumbar spine and is present in pelvic area. Eventually the fibrous tissue is ossified, with resulting bony ankylosis of the collapsed vertebrae. There may be an afternoon or evening fever. Types of Lesions in Spinal Tuberculosis Four types of lesion are known in spinal tuberculosis Paradiscal type — On the either side of disc Central type — central part of the vertebral body Anterior type — anterior surface of the vertebral body Appendicial type involving pedicles, laminae, spinous process or transverse processes. Each vertebra consist of an anterior body which is attached to a posterior ring called posterior neural arch [pedicle and laminae together]. Sometimes there may be multiple vertebrae may be involved which are separated by normal vertebrae termed as skip lesions. On xray, the diseased vertebral body loses the normal bony trabeculae and many show areas of destruction or the body may be expanded or ballooned out like a tumor and finally collapse like vertebra plana. Kyphosis is most marked in thoracic area because of the normal dorsal curvature. Extradural Granuloma and Tuberculoma Sequestra [dead bone] from avascular diseased vertebral bodies or intervertebral disc Granulation tissue on the with paridural fibrosis [cicatrization or scar formation] Infarction of the cord by thrombosis or artertitis. Pedicles, laminae and posterior surface of body forms boundaries of spinal canal, which is the space for passage of spinal canal. Thus first vertebra is called C1 and last vertebra is called C7. As the tuberculosis of spine progresses, vertebral bodies lose their mechanical strength due to progressive destruction under the force of body weight. As the disease progresses, the area of infection gradually enlarges and spreads to involve two or more adjacent vertebrae by extension beneath the anterior longitudinal ligament or directly across the intervertebral disc.
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