Spinal tumors and spinal tuberculosis are more common in clinical cases. Spinal tuberculosis has a high disability rate and has a great impact on the quality of life of patients. Spinal tumors and spinal tuberculosis are often difficult to distinguish. Unclear identification can easily lead to misdiagnosis and delay in treatment. The diagnosis and treatment cannot be obtained as soon as possible, and the disease condition or misdiagnosis is delayed. Therefore, this article mainly discusses some problems in the diagnosis of spinal tumors and spinal tuberculosis, hoping to make certain references in clinical work.
- Common causes of misdiagnosis of spinal tumors and spinal tuberculosis
1) The clinical manifestations of vertebral tuberculosis and tumors are similar to those of fatigue, weight loss, poor appetite, pain, and anemia. Individual tumor patients also have symptoms of low fever and night sweats. In physical examination, there are more signs of kyphosis, local percussive pain, and limited mobility, and the course of the disease is chronic. Therefore, the diagnosis is difficult and easy to be confused.
2) In some cases of spinal tuberculosis, there are no obvious symptoms and signs of tuberculosis poisoning such as weight loss, hot flashes, night sweats, fatigue, etc., and low back pain is a common clinical symptom and the earliest symptom of spinal tumor; l Whether it is spinal tumor or spinal tuberculosis Mild to severe spinal nerve dysfunction can occur due to the progression of the disease, including nerve root pain, sensory motor disorder, urinary incontinence, and even paraplegia, bone destruction, and can cause vertebral body collapse, wedge-shaped changes, and kyphotic deformity. In addition, some spine tumors can also have symptoms similar to tuberculosis poisoning, physical examination pick-up test, Thomas’ sign positive, differential diagnosis is difficult.
3) Insufficient understanding of the clinical features of this disease, thinking of tumors for gradually worsening lesions, ignoring the possibility of tuberculosis. The author believes that most spinal tuberculosis is primary tuberculosis, and the diagnosis of spinal tuberculosis cannot be denied clinically because there is no tuberculosis.
4) Unfamiliar with the significance and limitations of CT and MRI examinations, blindly relying on the results of medical examinations, causing misdiagnosis and missed diagnosis.
5) Inadequate understanding of the medical history, poor imaging examination quality, or inaccurate reading of imaging examination materials, resulting in diagnostic errors. The necessary differential diagnosis was not performed. Spinal tuberculosis and spinal tumors have similar symptoms and signs. If imaging is difficult to distinguish, the differential diagnosis is difficult. Experimental anti-tuberculosis treatment is of differential value.
- The value of MRI in the identification of spinal diseases
The anatomical structure of the spine overlaps significantly. MRI is one of the indispensable imaging examinations. There will be more and more MRI examinations for patients with spinal diseases. MRI has gradually become more and more important in the differential diagnosis of spinal tumors and tuberculosis. M RI is a non-invasive imaging examination method with high resolution of soft tissues and multi-directional imaging. M RI can well show the spatial relationship between the soft tissues and lesions around the spine and adjacent blood vessels and nerves, and can also judge the various components of the tumor and necrosis or bleeding. The advantages of MRI in the differential diagnosis of spinal tumors and tuberculosis: (1) Vertebral body: It can clearly show vertebral body abnormalities, even if there is no bone destruction, only bone marrow abnormalities can be displayed. This is what other imaging methods cannot do so far; (2) Intervertebral disc: Uninvolved intervertebral disc is an important feature of spinal tumors, while intervertebral disc stenosis caused by intervertebral disc involvement is an important feature of spinal tuberculosis. MRI shows whether the intervertebral disc is involved is more reliable; (3) Soft tissue: Although both tumors and tuberculosis will have soft tissue abnormalities, the formation of cold abscess is one of the important points of distinguishing spinal tumors and tuberculosis. With the help of the application of contrast agent, it is possible to clearly determine whether there is abscess formation and the shape and location of the abscess; (4) Blood supply: M RI soft tissue resolution is high, and there are obvious advantages in observation enhancement, and the enhancement mode directly reflects the blood supply of the lesion. . After spinal tuberculosis and tumor enhancement, the lesion showed mixed enhancement to varying degrees, which shows that the blood supply of tuberculosis and tumor is uneven.
- Prevention measures for misdiagnosis of spinal tumors and spinal tuberculosis
In view of the common causes of misdiagnosis, we can prevent it from the following aspects: 1) When distinguishing spinal tumors from most primary tuberculosis of the spine, the diagnosis of spinal tuberculosis cannot be denied because there is no history of tuberculosis. 2) In the clinical work, the young and middle-aged patients with low back pain are diagnosed as tuberculosis when the tumor or tuberculosis cannot be clearly identified by the imaging examination, and the bone marrow findings suggest infection. Anti-tuberculosis treatment is of differential value. 3) In the diagnosis of this type of disease, we must be careful about the medical history, and at the same time, we should carefully read the imaging materials. 4) Correctly understand the imaging manifestations of atypical spinal tuberculosis and spinal tumors, strive to improve the reading ability, comprehensively and systematically observe the imaging signs, and combine with clinical analysis to reduce misdiagnosis.
In summary, in medical practice, we must adhere to a serious and meticulous scientific attitude, conduct scientific diagnosis, scientific treatment, and implement targeted inspections to provide reliable evidence for diagnosis. In clinical work, attention should be paid to the diagnosis of spinal diseases. For patients who are suspected of unclear spinal diseases, only careful medical history, careful physical examination, reasonable application of auxiliary examinations, and broadening of diagnostic ideas should not only pay attention to the changes in the patient’s spinal lesions, but also Pay attention to the lesions in other relevant parts, and make comprehensive consideration and three-dimensional analysis, which can help us establish the correct diagnosis.