The Symptomatology and Diagnosis of Tuberculous Spinal Caries in Adults

Grieve, W. P (1926) The Symptomatology and Diagnosis of Tuberculous Spinal Caries in Adults. MD thesis, University of Glasgow.

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I have attempted throughout this work to consider the symptoms and signs of Pott's disease, in the adult, with reference to its early diagnosis. The length of time which elapses between the onset of symptoms and the diagnosis, especially in cases under supervision -in my series the average time was over two years -indicates a very unsatisfactory state of affairs. I have dealt in some detail with the production of the symptom of pain, as pain is, in the majority of patients, the first cause of complaint. The character of the pain in spinal caries, and its situation, do not definitely distinguish the disease from other causes of pain in the back; but they are at least suggestive of Pott's disease and this should always be excluded before pain is attributed to some other cause. This refers more particularly to the pain situated in the anti-gravity muscles of the back. In order that an early diagnosis may be made in cases of spinal caries in the adult, it is essential that signs and symptoms such as I have described, and pointing to the possibility of spinal disease, should always lead to an examination of the stripped back; and it is also necessary that the examiner should realise that, when tuberculous spinal caries is present in an adult, the spine itself is seldom painful. Should any doubt exist after the clinical examination, resort should be had to radiographic examination. The following conclusions may be drawn from the investigations I have made:- 1. Tuberculous spinal caries in the adult tends especially to affect the vertebrae from the 11th. thoracic to the 4th. lumbar. 2. Trauma is seldom present as a predisposing or contributory cause. 3. Pain, felt in the muscles of the back, is the most common initial symptom. It is less likely to be a prominent feature of the disease in muscular subjects, engaged in heavy work, than in those who lead sedentary lives. 4. The pain is the expression of inadequate postural tone in the anti-gravity muscles of the back. This tone, though inadequate, is relatively greater than the normal, and so produces rigidity; in consequence the pain is more constantly associated with the movements throwing a strain on the rigid muscles, than is the pain due to inadequacy of postural tone, arising from other causes. 5. The production of so-called' root pains', associated with spinal caries, is not always confined to the nerve roots themselves. In many cases they are the result of involvement of a peripheral nerve by a psoas abscess. Hyper-irritability of the nerve roots resulting from interference with their blood supply by an abscess, is the essential factor in the production of true root pains. 6. Pain in the back on jarring of the spine is not necessarily diagnostic of spinal caries. 7. The prevertebral abscess, in connection with disease of the thoracic region, does not tend to track away from the spine to the same extent as in other regions of the spine, and this may account for the greater frequency with which paraplegia and root pains are observed when the thoracic vertebrae are diseased; and also for the more marked deformities encountered in this part of the spine. S. Stiffness of the back is not a frequent cause of complaint inpatients suffering from Pott's disease. 9. Deformity is, in the majority of cases, present in some degree, usually very slight but detectable, at the time of onset of symptoms. 10. Muscular rigidity in the region of the spinal lesion is the most constant clinical sign of Pott's disease, and is always present so long as the disease is active. 11. Tenderness of the spine is uncommon in adult cases of spinal caries. 12. A patient, complaining of symptoms attributable to spinal disease, should always be examined with the back stripped, particular attention being paid to the signs of deformity and rigidity; and finally; X-ray examination of the spine should be made the deciding factor in cases of doubt. In this way, only, will it be possible to obtain cases for treatment at an early stage of the disease.

Item Type: Thesis (MD)
Qualification Level: Doctoral
Keywords: Medicine, Pathology
Date of Award: 1926
Depositing User: Enlighten Team
Unique ID: glathesis:1926-80636
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 30 Jan 2024 14:44
Last Modified: 30 Jan 2024 14:44

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