Pott's disease is an extrapulmonary tuberculosis of the spine that affects it for various reasons. The lower thoracic and upper lumbar vertebrae are most commonly affected.
Most of all, this infectious disease affects men. But it is diagnosed in many segments of the population. Tuberculous spondylitis develops very slowly, so it is quite difficult to detect pathology at an early stage.
Etiology and origin of spondylitis
Bacteria reach the site of infection through the bloodstream. The focus of the inflammatory process begins in the spongy bone. In 5% of cases, spondylitis is found on the posterior surfaces of the vertebral bodies.
As the disease progresses, tuberculosis of the spine gradually increases and spreads. Two or more adjacent bone elements are involved in the inflammatory process with expansion under the anterior longitudinal ligament or directly through the intervertebral disc. Sometimes there may be more than one involved, with he althy tissue separating them.
Howspinal tuberculosis progresses? Bone elements lose their mechanical strength due to increasing destruction under the influence of body weight. Excessive loosening of the links leads to angular deformation.
The severity of the distortion depends on the degree of destruction, the level of damage and the number of bone bodies involved in the pathological process.
Clinical manifestations of spondylitis
The initial signs are vague and often point to more than spinal tuberculosis. Symptoms may be similar to those for other pathologies that occur simultaneously in the body. These are manifestations such as:
- general malaise;
- easy fatigue;
- loss of appetite and weight;
- in children - loss of desire to play outdoors;
- Fever possible in the afternoon or evening.
Local signs are pain, spasm and soreness. They are less pronounced than in other diseases. Acute pain, as a rule, can characterize not only tuberculosis of the bones of the spine. Symptoms of the disease can be different: sometimes patients complain of stiffness.
Despite a large number of people suffering from the disease in the early stages, clinical signs may not appear. Many symptoms are absent even in the acute course of the disease.
External signs of tuberculous spondylitis
A person's gait changes almost immediately. Steps become short, patient has difficulty moving around.
Nerve root compressionleads to damage to the nervous system. She manifests:
- hyperactive tendon reflexes;
- muscle weakness;
- spastic gait.
In later stages, spinal tuberculosis in adults may be accompanied by deterioration of tendon reflexes in the following sequence:
- gait becomes clumsy;
- there is weakness in the limbs, you have to walk with support;
- muscles atrophy, the patient is unable to get out of bed, unable to move.
Causes of disease
Bacterial spinal infections are the most common type of pathology. They are caused by various microorganisms. The list of such diseases includes such ailments as:
- spondylitis;
- discite;
- spondylodiscitis;
- epidural abscess.
Often, microorganisms harmful to humans pass through the bloodstream in the vertebrae, which provoke spinal tuberculosis. Reasons for the development of the disease:
- physical injury;
- bad working conditions;
- infectious diseases.
The main cause of pathology is direct contact with an already infected person.
Main risk groups
The penetration of microorganisms into the lungs of a he althy person provokes the development of infection not only in the lungs, but also in the bone structures of the body.
At risk patient groups:
- smokerspersonality;
- malnourished;
- patients with AIDS or other similar diseases that cause a breakdown in the immune system;
- diabetics;
- those who abuse drugs.
Infection can occur even after surgery.
Classification of the disease and stages of development
There are two types of manifestation of the disease and five stages of development. Tuberculosis of the spine is bone and synovial. To hear such a diagnosis is very scary. It affects bone cartilage, destroys and destroys them, causing pathologies such as arthritis and arthrosis, which aggravate the course of the disease.
Stages in the development of spinal tuberculosis:
- First, a he althy person is infected.
- In stage 2, bacteria multiply very quickly, destroying he althy cells.
- The next is the appearance of the first symptoms.
- At the 4th stage, the reproduction of microorganisms reaches its climax, the spine is affected.
- The last stage is a repeated cycle in which the person himself becomes a carrier of the infection.
The development of the disease has three successive stages:
- Primary osteitis.
- Arthritic phase.
- Post-tritic phase.
If timely treatment is not started, the disease can be significantly delayed, which will lead not only to disability, but also to the death of the patient.
Diagnosis of spondylitis
Tuberculosis can be diagnosed byclinical and radiological examination.
Then the patient undergoes a differential diagnosis, including the collection of anamnesis, clarification of symptoms. Birth defects of the spine:
- Calvet disease (in young patients).
- Schmorl's hernia and Scheuermann's disease (may occasionally occur in adolescents).
With tuberculosis on X-ray examination, the fields of the vertebrae are fuzzy, the disk space is reduced.
To detect pathology, it is necessary to conduct laboratory tests:
- take a blood test;
- do ESR and CRP;
- examine the liver and kidneys;
- carry out a biopsy, borrowing tissue fragments for microbiological examination and accurate diagnosis of pathology.
Modern treatments
Before the advent of antibiotics, a large number of people died with a diagnosis of spinal tuberculosis. Treatment today has reached such heights that people can live with this disease for many years, maintaining a normal condition and regularly undergoing examinations. Thanks to the introduction of resuscitation units, the use of spinal devices, the cure of the disease became possible.
The treatment for tuberculous spondylitis is chemotherapy. The presence of a neurological deficit complicates the recovery process.
If the disease is diagnosed and treated at the earliest stages, before bone destruction and deformity occur, the patient is usually completelyrecovering.
Modern treatments are divided into 2 types:
- conservative therapy;
- surgery.
Both types certainly bring a positive effect. But conservative therapy does not always have the proper effect on the pathological process. An operative method of treatment has a better effect on a person who has a diagnosis of spinal tuberculosis. The operation is performed by qualified doctors, then the patient is under the supervision of the hospital staff for some time.
Conservative therapies
Treatment of patients with neuronal deficits is reduced to anti-tuberculosis chemotherapy. It is carried out with the use of drugs such as Isoniazid, Rifampicin, Pyrazinamide and Ethambutol. All of them are used as the first line of drugs that directly affect spinal tuberculosis. Symptoms of the manifestation of the disease will gradually go away if the treatment is carried out correctly. Depending on the course of the disease and the manifestation of symptoms, drugs may be replaced or added. The dosage is adjusted according to the patient's condition, age and weight.
Treatment with anti-tuberculosis drugs in bed gives long-term results and prevents recurrence.
Advanced patients require a more serious approach. The main treatment is chemotherapy and bed rest. Patients are placed in the clinic under the constant supervision of doctors and junior medical staff. conservativetherapy does not always give a positive result. In some cases, surgery is necessary.
Prompt approach to curing disease
Surgery is needed to decompress nerve structures and drain abscesses. Typically, these procedures are performed on children to correct growth-related deformities.
It is impossible to cure the disease on your own, since complete rest and complex treatment is required. When conservative therapy fails to cure spinal tuberculosis, symptoms in adults begin to worsen and there is a need for surgery.
The surgeon is faced with the task of removing a vertebra that has been affected by the disease. A transplant is placed in its place. The tissue needed for transplantation is taken from the patient's fibula. This is done so that the risk of rejection is minimized and there is a greater chance that the operation will help.
It must be remembered that the consequences of the disease can be irreversible, and surgical actions can affect spinal tuberculosis. Photos of patients with this infectious disease clearly provide vivid examples of the formation of pathology and its consequences.
Data obtained through X-ray and MRI allows surgeons to predict the outcome and determine the extent of the operation, as well as reduce the risk of complications after the operation.
It takes about 4 years for a full recovery. That is, even operationalintervention does not guarantee a quick recovery of the body. Many fatal cases have been recorded.
What is the probability of contracting spondylitis?
Spinal tuberculosis is contagious or not? Many people are puzzled by this question. But there is no exact answer to it. Highly qualified doctors have been working on this problem for years.
Of course, you need to beware of people with this diagnosis or take all precautions if the sick person is your relative or acquaintance.
Isolation of harmful microorganisms occurs only if:
- if the patient has an open form of tuberculosis;
- a he althy person was in contact with a sick person without observing the precautionary rules;
- eating from the same dish increases the risk of infection through the digestive tract.
Infection with spondylitis is possible in utero: if the mother is sick, infection occurs through the placenta. The likelihood of acquiring the disease is high through direct contact with a sick person.
Precautions and prevention
In tuberculosis of the spine, prevention is of great importance. Its methods are necessary to eliminate the risk of subsequent occurrence of the disease. It is very important to rest in time, to avoid excessive stress on the body as a whole.
Also try:
- do not get hypothermia;
- increase immunity;
- eat well and right;
- avoid injury.
The main preventive measure is timelytuberculosis vaccination. The injection is mandatory. It is necessary to protect the body from a dangerous infectious disease. They begin to do it at an early age, and the procedure is carried out in the first days of a child's life.
There is also a risk of contracting spondylitis in the workplace. Medical personnel working in this area have the highest risk of infection. They need regular check-ups and preventive TB drugs.
