[Medical Q&A] Spinal pain is accompanied by night sweats. What disease might I have?

Planner: Chinese Medical Association

Reviewer: Shao Zengwu, Chief Physician and Professor of Union Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology

Be alert to spinal tuberculosis.

The typical clinical manifestations of spinal tuberculosis are pain in the lesion site, weight loss, discomfort, night sweats, etc. Physical examination can reveal local tenderness, muscle spasm and limited spinal movement. Patients may have spinal deformity and neurological disorders, sometimes with paraplegia, kyphosis and sinus tract as the main complaints.

The pain site of spinal tuberculosis is consistent with the location of the disease, most commonly in the thoracic spine, followed by the lumbar spine, and less commonly in the cervical and sacral spine. Some patients may have paraspinal abscesses and abscesses in the groin and buttocks. 10% to 47% of patients develop paraplegia during the course of the disease. The incidence of paraplegia is higher when the disease occurs in the thoracic and cervical spine.

The incidence of paraplegia in patients with spinal tuberculosis is about 10%. Thoracic tuberculosis combined with paraplegia is more common, followed by cervical spine, cervicothoracic segment and thoracolumbar segment, and lumbar spine is the least common. The initial manifestations are back pain and a sense of bandage in the affected segment, followed by paraplegia. When spinal tuberculosis is complicated by high-level paraplegia, the patient not only suffers from quadriplegia, but also has respiratory muscles invaded, which makes suffocation and pulmonary complications very likely to occur. Clinically, the site of spinal cord compression can be determined by measuring the sensory plane. Bowel and bladder dysfunction occurs relatively late in patients with spinal tuberculosis complicated by paraplegia. The early manifestations are dysuria, which gradually develops into complete urinary retention. Urinary incontinence may occur when the reflex function of the bladder is restored. The initial manifestations of bowel dysfunction are constipation and abdominal distension, and loss of control may also occur.