Lumbar vertebra tuberculosis right leg pain

The lumbar spine is very important to us. If there is a problem with the lumbar spine, it means that the patient's body arterial function will be affected. When a lumbar spine disease occurs, the first thing to pay attention to is that there may be pain, and it may also cause pain in many other parts of the body. For this, we must find a way to receive treatment.

Overview

The vertebral body is mainly composed of cancellous bone, and its nutrient artery is a terminal artery, so tuberculosis bacteria can easily stay in the vertebral body. The lumbar spine has the greatest range of motion in the entire spine and the highest incidence of lumbar tuberculosis.

pathology

Lumbar tuberculosis is more common in adults. The lesions are limited to the upper and lower edges of the vertebral body and quickly invade the intervertebral disc and adjacent vertebral bodies. The disease is characterized by intervertebral disc destruction, resulting in a narrow intervertebral space. Cold abscesses formed after vertebral destruction can have two manifestations: 1. Paravertebral abscess: pus collects next to the vertebral body, either in the front, back or on both sides. It is more common to accumulate on the sides and front. The pus lifts up the periosteum and spreads upward and downward along the ligament gaps, causing bone erosion on the edges of several vertebrae. It can also move backward into the spinal canal and compress the spinal cord and nerve roots. ② Flowing abscess: When the paraspinal abscess accumulates to a certain amount, the pressure increases and it will penetrate the periosteum and flow downward along the myofascial gap, forming an abscess in a location far away from the lesion. The paraspinal abscess caused by lumbar spine disease penetrates the periosteum and accumulates in the psoas sheath to form a psoas abscess. Superficial psoas abscess can penetrate the lumbar fascia to the lumbar triangle and become a lumbar triangle abscess. The lumbar triangle is a potential space whose edges are the posterior edge of the iliac crest, the outer edge of the sacrospinal muscle, and the posterior edge of the internal oblique muscle. Psoas abscess can also flow along the psoas major muscle to the lesser trochanter of the femur, becoming a deep abscess in the groin. It can also bypass the back of the upper end of the femur, appear on the outside of the thigh, and even flow down along the fascia lata to the area above the knee.

Clinical manifestations

Onset is slow. There are systemic symptoms such as low fever, fatigue, weight loss, night sweats, loss of appetite and anemia.

Children often cry at night, are sluggish or irritable. Pain is the first symptom. It is usually mild pain that improves with rest and worsens with exertion. Early pain will not affect sleep; patients with a long course of the disease will also experience pain at night. When standing or walking, patients with lumbar tuberculosis often support their waist with both hands, tilt their head and torso backward to move their center of gravity backward and try to reduce the pressure of their body weight on the diseased vertebrae. When the patient picks up something from the ground, he cannot bend over and needs to straighten his waist, bend his knees and hips, and squat down to pick up the object. This is called a positive picking up test. Another examination method is to have the child lie prone, and the examiner lifts the child's feet with both hands, and gently lifts the lower limbs and pelvis. If there is a lumbar spine disease, the waist remains stiff due to muscle spasm, and the physiological lordosis disappears.

In the later stages, patients may develop psoas muscle abscesses, which may be seen or felt in the lumbar triangle, iliac fossa, or groin. Kyphosis in patients with lumbar tuberculosis is usually not serious. Mild kyphosis deformity can be detected by pressing along both sides of the sacrospinal muscles from the thoracic vertebrae to the sacrum with your fingers in sequence. A small number of patients come to see a doctor only after they discover a cold abscess.