结核性脊柱炎

,1,Case report,Patient information: JingXian Liu Female 78yNo. p733876left ureteral calculi combined with left kidney hydronephrosis(肾积水),结核性脊柱炎,Tuberculous Spondylitis ( Pott Disease ),4,Epidemiology,80% under 30y,Osteoarticular TB: 90% secondary to pulmonary TB,LTC （adults） TCL（kids）,骨关节结核：spine hip knee elbow joint,vertebra appendix alone involved is rare,5,Pathology,Mycobacterium tuberculosis spread hematogenously to paravertebral venous plexus（椎间静脉丛）anterior part of vertebral bodies are primary infected,then spread beneath the anterior spinal ligament, involving adjacent vertebra.In adults, disk disease is secondary to the spread of infection from the vertebral body. In children, the disk, because it is vascularized, can be the primary site.,6,Pathology,Progressive bone destruction leads to vertebral collapse and kyphosis（驼背）. The spinal canal can be narrowed by abscesses, granulation（粗糙） tissue, or direct dural invasion（硬膜侵犯）, leading to spinal cord compression and neurologic deficits. A cold abscess can occur if the infection extends to adjacent ligaments and soft tissues.,7,Clinical presentation,Common symptoms: malaise（不适）, loss of appetite, weight loss and night sweats. Neurological deficits: spine stiff , painful with movement, back muscle spasms（肌痉挛）, localized humpback（驼背）.,The symptoms are often insidious（隐匿） even during the active stage:,8,Radiographic features,bone destructionsequestrum（死骨）narrow/ disapear of intervertebral spacekyphosis deformity（后凸畸形）paravertebral abscess,9,Radiographic features,osteoporosis（骨质疏松） of vertebral bodyirregularity of the anterior vertebral margin of multiple levelsreduction in vertebral height,Ivory(象牙) vertebraea humpback deformityvertebra plana（扁平椎）paravertebral abscess,Plain radiograph,chest film is neccessary,sensitivie to calcificationbetter expression of sequestrum（死骨） formation,Radiographic features,CT,Cross-sectional imaging,epidural（硬膜） /cord compressionmarrow oedema & abnormal enhancement T1: hypointense marrow in adjacent vertebrae. T2: hyperintense marrow, disc, soft tissue infectionT1 C+ (Gd): marrow, subligamentous（韧带下）, discal, meninges enhancement,Radiographic features,MRI,paraspinal collections well circumscribed with enhancing margins,12,Pyogenic Spondylitis（化脓性脊柱炎）,differential diagnosis,differential diagnosis,differential diagnosis,differential diagnosis,Manegement & Prognosis,primary goal ：eradicate（消除） the infectionSecondary goals：maintain stability of affected spinal segments correcting the spinal deformities prevent paralysis maintain pulmonary functionTreatment：supportive care chemotherapy surgeryearly stages general supportive care and chemotherapy advanced cases Surgery is i