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1、,1,Case report,Patient information: JingXian Liu Female 78y No. p733876 left ureteral calculi combined with left kidney hydronephrosis(肾积水),结核性脊柱炎,Tuberculous Spondylitis ( Pott Disease ),.,4,4,Epidemiology,80% under 30y,Osteoarticular TB: 90% secondary to pulmonary TB,LTC （adults） TCL（kids）,骨关节结核：s
2、pine hip knee elbow joint,vertebra appendix alone involved is rare,.,5,5,Pathology,Mycobacterium tuberculosis spread hematogenously to paravertebral venous plexus（椎间静脉丛） anterior part of vertebral bodies are primary infected,then spread beneath the anterior spinal ligament, involving adjacent verteb
3、ra. In adults, disk disease is secondary to the spread of infection from the vertebral body. In children, the disk, because it is vascularized, can be the primary site.,.,6,6,Pathology,Progressive bone destruction leads to vertebral collapse and kyphosis（驼背）. The spinal canal can be narrowed by absc
4、esses, granulation（粗糙） tissue, or direct dural invasion（硬膜侵犯）, leading to spinal cord compression and neurologic deficits. A cold abscess can occur if the infection extends to adjacent ligaments and soft tissues.,.,7,7,Clinical presentation,Common symptoms: malaise（不适）, loss of appetite, weight loss
5、 and night sweats. Neurological deficits: spine stiff , painful with movement, back muscle spasms（肌痉挛）, localized humpback（驼背）.,The symptoms are often insidious（隐匿） even during the active stage:,.,8,8,Radiographic features,bone destruction sequestrum（死骨） narrow/ disapear of intervertebral space kyph
6、osis deformity（后凸畸形） paravertebral abscess,.,9,9,Radiographic features,osteoporosis（骨质疏松） of vertebral body irregularity of the anterior vertebral margin of multiple levels reduction in vertebral height,Ivory(象牙) vertebrae a humpback deformity vertebra plana（扁平椎） paravertebral abscess,Plain radiogra
7、ph,chest film is neccessary,.,10,sensitivie to calcification better expression of sequestrum（死骨） formation,Radiographic features,CT,Cross-sectional imaging,.,11,epidural（硬膜） /cord compression marrow oedema & abnormal enhancement T1: hypointense marrow in adjacent vertebrae. T2: hyperintense marrow,
8、disc, soft tissue infection T1 C+ (Gd): marrow, subligamentous（韧带下）, discal, meninges enhancement,Radiographic features,MRI,paraspinal collections well circumscribed with enhancing margins,.,12,12,Pyogenic Spondylitis（化脓性脊柱炎）,differential diagnosis,.,13,differential diagnosis,.,14,differential diagn
9、osis,.,15,differential diagnosis,.,16,Manegement & Prognosis,primary goal ：eradicate（消除） the infection Secondary goals：maintain stability of affected spinal segments correcting the spinal deformities prevent paralysis maintain pulmonary function Treatment：supportive care chemotherapy surgery early stages general supportive care and chemotherapy advanced cases Surgery is indicated only for disease-related complications such as cold abscess,paraplegia （截瘫）,tuberculous lesions, and deformity,Thanks For Attention,/10/29,.,18,
