University of California San Francisco, Department of Orthopaedic Surgery, UCSF Benioff Children's Hospital Oakland, 747 52nd St, Oakland CA 94605, USA.
University of California San Francisco, Department of Orthopaedic Surgery, UCSF Benioff Children's Hospital Oakland, 747 52nd St, Oakland CA 94605, USA.
Spine J. 2019 Nov;19(11):1858-1870. doi: 10.1016/j.spinee.2019.05.002. Epub 2019 May 15.
Nearly one-third of the human population is infected with tuberculosis. Of those with active disease, approximately 10% are impacted by skeletal tuberculosis. Though, traditionally a disease of the developing world and susceptible populations, with the rise of immigration, patients may present in developed countries. The microbe responsible is the mycobacterium tuberculosis complex bacillus. The infection begins in the anterior vertebral bodies. The natural history and presentation are notable for cold abscesses causing mass effect, early or late neurological deficit, and kyphotic deformity of the spine caused by anterior vertebral body destruction. The disease can be diagnosed with laboratory studies and characteristic imaging findings, but tissue diagnosis with cultures, histology, and polymerase chain reaction is the gold standard. The cornerstone of medical management is multidrug chemotherapy to minimize relapse and drug resistance, and can be curative for spinal tuberculosis with minimal residual kyphosis. Surgical management is reserved for patients presenting with neurological deficits or severe kyphosis. The mainstays of surgical management are debridement, correction of spinal deformity and stable fusion. With appropriate and timely management, clinical outcomes of the treatment of spinal tuberculosis are overall excellent.
全球近三分之一的人口感染了肺结核。在患有活动性疾病的人群中，约有 10%受到骨骼结核的影响。尽管这种疾病传统上是发展中国家和易感人群的疾病，但随着移民的增加，患者可能会出现在发达国家。引起这种感染的微生物是结核分枝杆菌复合体杆菌。感染始于前椎体。其自然病史和表现为寒性脓肿引起的肿块效应、早期或晚期神经功能缺损以及前椎体破坏引起的脊柱后凸畸形。可以通过实验室研究和特征性影像学发现来诊断这种疾病，但组织学诊断包括培养、组织学和聚合酶链反应是金标准。医学治疗的基石是多药化疗，以最大限度地减少复发和耐药性，对于脊柱结核，最小化残留后凸畸形可以实现治愈。手术治疗仅适用于出现神经功能缺损或严重后凸畸形的患者。手术治疗的主要方法是清创、矫正脊柱畸形和稳定融合。通过适当和及时的治疗，脊柱结核的治疗临床效果总体上非常好。
