1、脊柱结核 Spine Tuberculosis(TB),瞿东滨 By : Prof Dr Qu Dongbin 南方医科大学南方医院脊柱骨科 Southern Medical University Nanfang Hospital,Skeletal remains from a Neolithic Settlement in the Eastern Mediterranean show prehistoric humans (7000 BC) had TB, and tubercular decay has been found in the spines of mummies from 30
2、002400 BC,Source: WHO 2002.,Morbidity rate of tuberculosis in 2000,Estimated TB incidence, prevalence and mortality, 2009,From WHO 2010 data,Tuberculosis (TB, for Tubercle Bacilli) is contagious and airborne. It is a disease of poverty affecting mostly young adults in their most productive years. Th
3、e vast majority of TB deaths are in the developing world 1.7 million people died from TB (including 380 000 women) in 2009, including 380 000 people with HIV, equal to 4700 deaths a day The TB death rate has fallen by 35% since 1990, and the number of deaths is also declining TB is among the three g
4、reatest causes of death among women aged 15-44 There were 9.4 million new TB cases (including 3.3 million women) in 2009, including 1.1 million cases among people with HIV,From WHO 2010 data,Mycobacterium Tuberculosis,acid-fast bacillus,Robert Koch found TB bacilli in 1882 The day, March 24, he decl
5、ared his findings in Berlin, is celebrated as World Tuberculosis Day from 1995,2003年摄于柏林Charite医院,Bacillum Calmette-Gurin, or BCG, for short（1921）,Lon Charles Albert Calmette（1863-1933）,Jean-Marie Camille Gurin ( 1872 1961),Antibiotic chemotherapy: the cornerstone,streptomycin（1946） isoniazid（1951）
6、pyrazinamide（1956） rifampicin（1965） ethumbutol（1961）-first-line drugs,Selman Waksman,Song of the Burial of Flowers - I hold a burial when you die today, But theres no telling when I pass away. 尔今死去侬收葬，未卜侬身何日丧？ Others laugh at me that have buried thee, Who will be the one that shall bury me?侬今葬花人笑痴，他
7、年葬侬知是谁？ The end of spring makes flowers fall one by one, Its also the time when beauty meets its doom. 试看春残花渐落，便是红颜老死时。Once beauty is carried to its very tomb, Both beauty and flowers perish known to none. 一朝春尽红颜老，花落人亡两不知！,From Cao Xueqin : The story of the stone,Spinal Tuberculosis,Described first
8、by Pervical Pott in 1782 Counts for 35% of TB Counts for 15% of extrapulmonary TB Counts for 50% of skeletal TB Cervical spine 5% Thoracic spine 25% Lumbar and sacral spine 20%,Angular kyphosis Paralysis 9-year-old child treated successfully in 1998,Paravertebral abscess,Sinus formation caused by lu
9、mbar tuberculosis,Diagnosis of Spine TB,symptoms +signs,X-ray/ MRI /CT findings,ESR/CRP ,Pathological findings,TB-SPOT(+),Clinical Diagnosis,Antituberculous chemotherapy trials,Langerhans cell,T12,L1,X-ray,Sandwich-like destruction Note: pedicle morphology,X-ray,Paravertebral abscess: Spindle-shaped
10、 soft tissue mass Note: span over two or more vertebral bodies,CT-scan,Paravertebral abscess: spindle-shaped and ring-like soft tissue mass Note: dead bone or sequestration,MRI-scan,T1W1/T2: low-density signals Enhanced: high-density signals Destruction of adjoining vertebral bodies Paravertebral ab
11、scess Spinal cord compression,MRI-scan,MRI-scan,Psoas abscess,椎间盘型 椎体型 椎弓型 全椎骨型 跳跃型 多骨结核型 椎管内型,肿瘤 转移癌骨髓瘤淋巴瘤 炎症 强直性脊柱炎终板炎骨质疏松椎体压缩骨折 感染 布鲁氏菌病化脓性脊柱炎真菌,Differential Diagnosis: spine metastatic tumor,intervertebral disc(disc gap) pedicle/posterior structures,vertebral body vs posterior structures,Spinal
12、structures affected,adjoining vs skipping,Vertebrae affected,anterior p. vs posterior p.,Vertebral body affected,Endplate affected,insect-bite vs fracture,Paravertebral mass,Long spindle-like or local peak hill,ring vs local,Paravertebral mass,liquid composition within the mass,Paravertebral mass,“d
13、ead bone” and harden ring,If still confused?,CT-guided biopsy,metastatic breast cancer,Bed rest Fresh air Nutrients Sunshine,Supportive management,Spine TB is the general TB-induced infectious disease affecting the spine,Conservative management,Regular anti-tuberculous chemotherapy immobilization,Ai
14、ms Debridement Release compression of spinal cord and nerves Correction of spinal deformity Reconstruction of spinal stability,Surgical management,AIMS,INDICATION,PROCEDURE,PATIENT,Surgical thinking for spine TB,?,Surgical treatment,2011-03-31,2011-04-12,2011-04-19,2011-07-24,Summary,Spine tuberculo
15、sis is discussed today. The clinical manifestation of spine TB should be known. The differential diagnosis of Spine TB and Spine Metastatic Tumors should be known. If interested in this topic, search “spine tuberculosis” or “spinal tuberculosis” in Pubmed to find some REVIEW papers for further reading. If any question, please let me know or discuss with Dr Wang Haiming.,
