[Clinical features, diagnosis and treatment of solitary vertebral arch tuberculosis].

OBJECTIVE

To explore clinical features of vertebral arch tuberculosis, and to discuss the diagnosis and treatment of this illness.

METHOD

Seventeen of 3,825 cases of spinal tuberculosis who were hospitalized and treated from 1956 to 1996 were reviewed, and their clinical features, diagnosis and treatment were analyzed and reported.

RESULT

Sixteen cases of vertebral arch tuberculosis were in adolescence and prime of life, and another one was a 2-year-old child. Their symptoms in early stages were untypical, including local fixed pain and tenderness, and later, abscess, fistula and symptoms of nerve system appeared. All the cases were diagnosed through summarizing of their history, signs, imaging examination and bacteriology tests, and only one case was misdiagnosed. In one of 17 cases, antituberculosis chemotherapy was conducted alone and non-operation was performed. In the other 16 cases, focal debridement of vertebral arch was performed on the basis of antituberculous chemotherapy, and in 4 cases of them with symptoms of nerve system, laminectomy and spinal decompression was performed homochronously. All the cases were healed and no relapse occurred during follow-up.

CONCLUSION

It is difficult to diagnose vertebral arch tuberculosis in early stages due to its occult symptoms, but the symptom of confined pain and manifestation in X-ray, CT and MRI are much useful for early diagnosis. Abscess puncture and acid-fast staining smear microscopy can usually be used to confirm diagnosis. And surgical intervention is an important measure for its treatment.