Both bone and disc spaces are involved in which spine disease -
Ans. is 'a' i.e., Tuberculosis Pathology of tuberculosis of spine:* Like tuberculosis of the bones and joints elsewhere in the body, TB of the spine is always secondary.The bacteria reach the spine via the haematogenous route, from the lungs or lymph nodes. It spreads via the paravertebral plexus of veins i.e., Batson's plexus, which has free communication with the visceral plexus of the abdomen, a common site of tuberculosis.Types of vertebral tuberculosis :* Lesions in the vertebrae may be of the following types :a) Paradiscal: This is the commonest type. In this, the contiguous areas of two adjacent vertebrae along with the intervening disc are affected.b) Central: In this type, the body of a single vertebra is affected. This leads to early collapse of the weakened vertebra. The nearby disc may be normal. The collapse may be a 'wedging' or concertina' collapse; wedging being commoner.c) Anterior: In this type, infection is localised to the anterior part of the vertebral body. The infection spreads up and down under the anterior longitudinal ligament.d) Posterior: In this type, the posterior complex of the vertebra i.e., the pedicle, lamina, spinous process and transverse process are affected.Pathology:* In the commoner paradiscal type, bacteria lodge in the contiguous areas of two adjacent vertebrae.* Granulomatous inflammation results in erosion of the margins of these vertebrae.* Nutrition of the intervening disc, which comes from the end-plates of the adjacent vertebrae is compromised. This results in disc degeneration, and as the process continues, complete destruction. Thus both bone and disc spaces are involved in tuberculosis of spine.* Weakening of the trabeculae of the vertebral body results in collapse of the vertebra.* Type of collapse is generally a wedging, occurs early, and is severe in lesions of the dorsal spine. This is because, in the dorsal spine the line of weight bearing passes anterior to the vertebra, so that the anterior part of the weakened vertebra is more compressed than the posterior, resulting in wedging.* In the cervical and lumbar spines, because of their lordotic curvature (round forwards), wedging is less. Destruction occurs early, and is severe in children.
Tuberculosis
Osteoporosis
Osteoid osteoma
Eosinophilic granuloma
Tuberculosis of Bone & Joints