Schlesinger Naomi, Lardizabal Alfred, Rao Jayanti, Rao Jyoti, McDonald Reynard
Department of Medicine, Rheumatology Division, University of Medicine and Dentistry of New Jersey/Robert Wood Johnson University Hospital, 1 Robert Wood Johnson Place, PO Box 19, New Brunswick, NJ 08903-0019, USA.
J Clin Rheumatol. 2005 Feb;11(1):17-20. doi: 10.1097/01.rhu.0000152144.91206.0c.
It is estimated that 10 to 15 million people are infected with Mycobacterium tuberculosis in the United States. Spinal involvement is said to occur in less than 1%.
A review of the clinic records of all patients having a diagnosis of spinal tuberculosis at the New Jersey Medical School National Tuberculosis Center from January 1994 to January 1999 was done.
Twelve patients with spinal TB were identified (2.2%). Spinal tuberculosis is characteristically chronic and slowly progressive. Presenting symptoms are usually back and neck pain or pain at the site of involvement. Pain was noted in a majority (83%) of our patients. Despite proven diagnoses by culture or histology, only 41% were purified protein derivative-positive. Unlike pulmonary tuberculosis, which may present with a constellation of symptoms, including cough, weight loss, fever, and night sweats, if tuberculosis only involves bone, pain may be the only symptom. Most patients were successfully treated with surgery and anti-TB medications. Tuberculosis remains a major public health problem.
Before the disease can be treated, it must be recognized. Tuberculosis should be considered a diagnostic possibility when spinal osteomyelitis is seen, even in the absence of pulmonary disease or HIV infection. Back pain in a patient with tuberculosis should be evaluated. Early initiation of an appropriate treatment regimen may reduce the need for surgical intervention, but most patients require surgery.
据估计，美国有1000万至1500万人感染结核分枝杆菌。据说脊柱受累的发生率不到1%。
对1994年1月至1999年1月在新泽西医学院国家结核病中心诊断为脊柱结核的所有患者的临床记录进行了回顾。
确定了12例脊柱结核患者（2.2%）。脊柱结核的特点是慢性且进展缓慢。主要症状通常是背部和颈部疼痛或受累部位疼痛。我们大多数（83%）患者都有疼痛症状。尽管通过培养或组织学已确诊，但只有41%的患者结核菌素纯蛋白衍生物试验呈阳性。与可能出现包括咳嗽、体重减轻、发热和盗汗等一系列症状的肺结核不同，如果结核仅累及骨骼，疼痛可能是唯一症状。大多数患者通过手术和抗结核药物治疗成功。结核病仍然是一个主要的公共卫生问题。
在疾病能够得到治疗之前，必须先予以识别。当见到脊柱骨髓炎时，即使没有肺部疾病或HIV感染，也应考虑结核病的诊断可能性。对结核病患者的背痛应进行评估。尽早开始适当的治疗方案可能会减少手术干预的必要性，但大多数患者仍需要手术。
