Tuberculosis of the vertebrae conforms fairly closely in its time and mode of origin to the principles applying to other hematogenous disseminations. The disease usually starts in early childhood or during adolescence and early adult life; in the latter period some of the newly developing lesions probably result from the exacerbation of latent foci established many months or years previously.
The localization, evolution, and healing of vertebral lesions, likewise, are governed by principles which apply to other structures. The compactness, growth, vascularity, and other components of the bone, as well as the differences in native and acquired resistance, help explain the differences of behavior at various ages.
In negroes, vertebral tuberculosis is a more frequent, serious, and fatal disease than in whites.
In the presence of vertebral tuberculosis, a source in the chest should always be assumed and sought for, as well as hematogenous lesions in other systems such as the serous membranes, the lymphatics, and the genito-urinary tract. It is important to recognize these at any time, but especially during the early stages of vertebral disease. Periodic roentgenographic examinations of the chest should be made at frequent intervals, and the urine should be examined regularly for traces of albumin or Pus. Suggestive evidence should always lead to further investigation. Too much reliance should not be placed on the observation that vertebral tuberculosis sometimes runs its course as an isolated lesion.
Treatment is aimed first at arresting hematogenous dissemination, diffusion of toxins from the vertebral lesions, and the destructive processes of caseation and liquefaction. Later, adequate time should be allowed for complete healing, which may require several years. Healing sets its Own pace, and this cannot be accelerated materially except by rest treatment in its comprehensive meaning. Other measures may aid in securing a better, if not a quicker, result.
Attention is called to the principle that in any form of tuberculosis surgical treatment usually is most effective ultimately if it is postponed until the forces of resistance have become organized and the lesion has been stabilized and has started to heal. Surgical treatment. may be futile and harmful if started prematurely, especially if the disease is still in the phase of hematogenous dissemination.
(C) 1940 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.