Lumbar Spine Tuberculosis

Lumbar spine TB, commonly called tortoiseshell inflammation, has high incidence and ranks first among systemic osteoarticular TB; the vast majority is vertebral body TB, with lamina, spinous process, articular process, and transverse process TB being very rare.

Common Symptoms

Low back pain; motor dysfunction; persistent pain

Causes and Pathogenesis

Etiology: Like TB elsewhere, lumbar TB is mostly from pulmonary TB; bacilli spread hematogenously to bone tissue. Most are killed, but a few evade drugs and hide; when immunity declines they establish infection causing bony destruction. Bacilli prefer vascular areas; vertebral bodies are mainly cancellous bone with terminal nutrient arteries and slow venous flow, so bacilli lodge there. The lumbar spine is the most mobile, giving it the highest incidence. Pathophysiology: Lumbar TB is more common in adults, starting at vertebral endplates and quickly invading discs and adjacent bodies. Disc destruction is characteristic, causing narrowed disc spaces. Two types of cold abscess: (1) Paravertebral: pus collects beside the vertebrae (usually anterior/lateral), elevating periosteum and tracking up/down along ligamentous planes, eroding multiple vertebral margins; it can enter the spinal canal compressing the cord and nerve roots. (2) Gravitational: When paravertebral pressure rises, pus penetrates periosteum and tracks along fascial planes to distant sites. Lumbar lesions form psoas abscesses; superficial ones can track to the lumbar triangle (bordered by iliac crest, sacrospinalis, and internal oblique), or along the psoas to the lesser trochanter forming a deep inguinal abscess, or around the femur to the lateral thigh, or down the fascia lata to above the knee.

Treatment

Surgical treatment, drug therapy, supportive therapy

Preventive Measures

1. Control system: Establish TB control organizations. 2. Treatment setting: Effective home or hospital therapy cures and converts sputum. 3. Case finding: Sputum-positive patients are sources; one infects 5-10 yearly. 4. Case management: Register patients; long-term treatment demands safe, effective, affordable regimens. 5. BCG vaccination for uninfected neonates, children, and adolescents. Controlling sources, cutting transmission, and enhancing immunity are the basic principles.

Department to Visit

It is recommended to visit the Orthopedic Surgery department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.