Parspinous tuberculosis

　　The incidence of vertebral body tuberculosis is high, ranking first among bone and joint tuberculosis, while parspinous tuberculosis is very rare. Parspinous tuberculosis is more common in young and middle-aged adults, and children are less affected. The cause is similar to other tuberculosis diseases, mainly caused by the colonization of tuberculosis bacilli in this location through the blood flow.

　　Pars interarticularis tuberculosis often presents with swellings, abscesses, or sinus tracts. The spine shows no deformity, and movement is not obviously restricted. The abscesses of parspinous tuberculosis are mostly located at the posterior part of the spine near the focus, but a few cases of lumbar transverse process tuberculosis may have abscesses that can form not only on the posterior part of the spine but also can invade the psoas major muscle attached to the transverse process, forming an abscess of the psoas major muscle and a descending iliac fossa abscess. The complications of this disease include the following:

　　1. Metastatic cancer

　　Older in age, more common in vertebral bodies, and can also invade the pedicle root. X-ray shows osteolytic destruction as the main feature. Prostate cancer and breast cancer metastasis can cause osteogenic changes.

　　2. Aneurysmal bone cyst

　　Commonly seen in the vertebral plate, and sometimes a mass can be palpated. X-ray films show expansive osteolytic changes and expansion into soft tissue.

　　3. Spinal cord tumor

　　Compressing the surrounding bone, forming marginal bone destruction, the tumor grows larger and involves the pedicle root, and can also involve the costal head or vertebral plate on the same side later.

　　4. Acute suppurative inflammation

　　Most cases have an acute onset, with high fever and severe pain as the starting point, with local acute inflammatory manifestations. X-ray films show extensive lesions, and bone sclerosis is common.

　　Pedicle tuberculosis is more common in young and middle-aged adults, and there is a significant difference in the incidence rate between males and females. The systemic symptoms are often not obvious, and the most common site of onset is the thoracic vertebra, followed by the lumbar and cervical vertebrae. The lesions are often located in the pedicle of the thoracic vertebra, surrounding the spinal cord in three directions, with compression of the spinal cord coming from the posterior side. Therefore, 25% to 50% of the cases may develop paraplegia, which is higher than the frequency of paraplegia in vertebral body tuberculosis. In addition to pain at the site of the lesion, radicular pain is also common. The lesions are close to the surface of the body, the course is shorter than that of vertebral tuberculosis, and they often appear in the middle line of the spine, with肿块, abscesses, or sinus tracts. The spine is usually not deformed, and there is no obvious limitation in activity.

　　The cause of pedicle tuberculosis is the same as that of other tuberculosis diseases, mainly caused by the invasion of the tuberculosis bacillus into the blood and colonization in that area. Active treatment of tuberculosis is the key to the prevention and treatment of this disease. To prevent the spread of tuberculosis and prevent infection, attention should be paid to frequent opening of windows and ventilation in living rooms and offices, at least for half an hour each day. Do not spit on the ground, and the spittoon should be disinfected. Pay attention to physical exercise in daily life, enhance physical fitness, and improve immunity.

　　The X-ray film of the vertebral column in anteroposterior position can be taken, and oblique position films can also be taken when necessary. The manifestations are different according to the different lesions. X-ray film of the pedicle root lesion shows round or elliptical shadows above the superior pedicle of the vertebral body, with asymmetrical osteolytic destruction that is indistinct. X-ray film of the vertebral plate lesion shows low bone density on both sides of the spinous process. X-ray film of the spinous process lesion shows that the original shadow of the spinous process is partially or completely absent when compared with the normal spinous processes above and below. In addition to X-ray, CT scan can also be used. With the high resolution of CT, even the subtle destruction of the pedicle can be detected.

　　Patients with pedicle tuberculosis have a particularly poor appetite. To increase appetite, one can focus on cooking, making sure the variety is diverse, and the color, smell, taste, and shape are good. Those who have the conditions can add two more snacks in addition to the three regular meals a day. It is advisable to avoid eating刺激性 foods and foods that produce phlegm and heat.

　　Patients with pedicle tuberculosis can also eat more seafood, such as seaweed, deep-sea fish, and prawns. The nutritional value of marine life is very high. Detection shows that every 100 grams of shrimp meat contains 20.6 grams of protein, and also contains fat, ash, and calcium, phosphorus, iron, vitamins, and riboflavin, among other components. The body also contains troponin and tropomyosin, so it is not only a delicacy but also has the functions of tonifying the kidney and Yang, nourishing the Yin and strengthening the bones, and calming the mind. It can be used to treat various diseases such as tetany of the hands and feet, skin ulcers, chickenpox, muscle and bone pain, and pedicle tuberculosis.

　　Vitamins and inorganic salts play a significant role in the promotion of tuberculosis recovery. Among them, vitamin A has the effect of enhancing the body's ability to resist diseases. Vitamins B and C can improve various metabolic processes in the body, increase appetite, and improve the function of lung and vascular tissues. For patients with recurrent hemoptysis, iron supply should be increased, and more green vegetables, fruits, and杂粮 should be eaten to supplement various vitamins and minerals.

　　The above is an introduction to how vertebral arch tuberculosis patients should eat. Because tuberculosis is a consumptive disease, while using drug treatment and dietary adjustment, it is also necessary to ensure adequate rest and appropriate outdoor activities. In addition, it is important to clearly understand the symptoms of vertebral arch tuberculosis in daily life to ensure early detection and treatment of the disease.

　　Because vertebral arch tuberculosis has a smaller volume and the lesion location is much shallower than vertebral tuberculosis, treatment tends to be surgical. However, it is still necessary to consider two situations:

　　1. For a few cases with mild lesions and a short course of disease, without abscesses, fistulas, or neurological symptoms locally, non-surgical treatment can be considered. This means mainly through anti-tuberculosis drug treatment to make the lesion stationary and cured.

　　2. Most vertebral arch tuberculosis should be actively treated with surgical excision of the focus under systemic anti-tuberculosis drug treatment to prevent the progression of the lesion into the spinal canal, causing neurological symptoms and paraplegia. During the operation, it is necessary to thoroughly remove bone lesions and abscesses, tuberculous granulomas, caseous necrosis, and other substances. Due to the small size and irregular shape of the vertebral arch lesions, scraping is often not thorough enough, and the operation usually involves excision of the base of the lesion bone. When dealing with vertebral plate and pedicle tuberculosis, attention should be paid to avoid entering the spinal canal to prevent damage to the dura mater and spinal nerves. For those who need to enter the spinal canal to remove lesions and perform spinal canal decompression, care should be taken to avoid damaging the dura mater, and immediate suture should be performed if there is a tear to prevent subdural infection and adhesions. At the end of the operation, it is necessary to thoroughly flush and place drainage items (strips, sheets, tubes) to ensure adequate drainage to prevent infection and fistula formation. Postoperative anti-tuberculosis drug treatment should continue for 6 to 9 months.