How bones and joints are affected
Mycobacteria settle in areas of the bone with a good blood supply - in the vertebral bodies and near the articular ends. A focus of inflammation is formed in which the bone tissue is gradually destroyed. In the spine, the vertebrae adjacent to each other and the disc located between them suffer, due to which the height of the segment decreases and angular deformity occurs. Pus can spread along the muscles, forming an abscess far from the source. The cartilage in the joint is destroyed, contracture and stiffness develop.
- Tuberculous spondylitis - damage to the spine
- Destruction of vertebral bodies and disc
- Angular deformity and hump formation
- Severe abscesses along the muscles
- Tuberculous coxitis and drives
- Cartilage destruction and joint contracture
- Risk of spinal cord compression
Causes and risk factors
The disease is caused by Mycobacterium tuberculosis, which enters the bones through the bloodstream from a pulmonary or other source, often years after the initial infection. Activation is facilitated by weakened immunity. Therefore, people with HIV infection, diabetes mellitus, chronic renal failure, receiving glucocorticosteroids and genetically engineered drugs, exhausted patients and the elderly are at risk. Contact with a patient with tuberculosis, poor living conditions and alcohol abuse are also important.
- Past or active pulmonary tuberculosis
- Contact with a patient with tuberculosis
- HIV infection
- Diabetes mellitus
- Long-term use of glucocorticosteroids
- Old age and exhaustion
- Alcohol abuse
Symptoms
The first and most consistent symptom is pain. When the spine is affected, it is local, intensifies with loading and tapping, does not go away completely with rest and often wakes you up at night - this fundamentally distinguishes it from ordinary pain in osteochondrosis. Stiffness appears, the person spares his back, and his posture changes. When a joint is damaged, pain, limited movement and lameness increase, and the muscles around the joint lose weight. General symptoms are moderate: prolonged low temperature, sweating, weakness, weight loss.
- Persistent local pain in the back or joint
- Pain at rest and at night
- Stiffness and gentle posture
- Lameness and limitation of movement
- Muscle atrophy around the joint
- Spinal deformity
- Weakness in the legs due to spinal cord compression
- Low-grade fever and weight loss
Diagnostics
X-ray reveals changes quite late, so if suspected, magnetic resonance imaging is prescribed: it shows inflammation in the vertebral body, disc destruction, leaky abscesses and the condition of the spinal cord at an early stage. CT scans better demonstrate bone destruction and help plan surgery. A biopsy of the lesion must be performed with histological examination, culture, and a molecular genetic test that determines the resistance of the pathogen. Additionally, they do X-rays of the lungs, blood tests and HIV testing.
- MRI of the affected area is the method of choice
- X-ray of a bone or joint
- CT scan to assess bone destruction
- Biopsy of the lesion with histology and culture
- Molecular genetic test for mycobacteria
- Chest x-ray
- Complete blood count, ESR, C-reactive protein
- Screening for HIV and diabetes
Treatment and recovery
The basis of treatment is long-term combined anti-tuberculosis therapy, which for bone forms usually lasts from nine to twelve months, and longer for resistant pathogens. Additionally, unloading of the affected area, an orthopedic regimen, and then gradual rehabilitation are necessary. Surgical treatment is required for spinal cord compression, spinal instability, large abscesses and severe deformity: the destroyed tissue is removed and fixation is performed. Adequate nutrition and treatment of concomitant diseases are mandatory.
- Anti-tuberculosis therapy 9–12 months or longer
- Observation by a phthisiatrician and monitoring drug tolerance
- Unloading and fixing the affected area
- Surgery for spinal cord compression and instability
- Drainage of large abscesses
- Gradual rehabilitation and physical therapy
- Good nutrition and diabetes control