—This is the most striking objective feature of well-marked Pott’s disease. It is practically a backward projection known as kyphosis, the vertebra first affected being usually the first to yield, the others following or changing in shape as the disease spreads or as the growth of the individual permits accommodation and necessitates rearrangement. The more acute the disease the sharper the projection. Old and mild cases cause an abrupt curvature rather than a protuberance.
Fig. 253
Fig. 254
Typical postures of the spinal muscle spasm of spondylitis. (Bryant.)
It is well to keep a record of the deformity in cases under treatment. This may be graphically preserved by putting the patient flat upon the abdomen upon a straight surface and bending a strip of lead so that it shall fit the contour of the spinous processes. After it has been made to fit it may be removed and a tracing of the curve made upon a sheet of paper. Comparison of tracings thus made at intervals will afford a graphic record of the progress of the disease or of the improvement made. Kyphotic deformities lead to a shortening of the spine, so that growth is stunted and patients become dwarfed in appearance. Secondary curvatures are produced above and below the primary projection. Gradually as the shape of the vertebral bodies and of the entire spinal column changes the ribs are pressed more or less together, often being made to overlap, the shape of the chest undergoes alterations, the sternum sometimes being depressed and sometimes protruded, giving the chest, in the latter case, the so-called “pigeon-breast” appearance.
Loss of Function.
—There are but few disorders which produce more pronounced and widespread accompaniments than spinal caries. As change in the shape of the spine occurs and assumes a marked type we see changes occurring through the body, not only in the direction of anemia with general impairment of function, mental irritability, and cachexia, but there occur trophic alterations as well. The shape of the face changes, the expression assumed is one of anxiety, and the features become less mobile.
Complications and Sequels.
—Tuberculous meningitis, cerebral or spinal, is the most dangerous and acute condition, while other tuberculous complications may occur in various regions of the body. In fatal cases meningitis, in consequence of acute or mixed septic and terminal infection, furnishes the explanation for the great majority. Paralysis is not infrequent as a sequel, assuming the type of paraplegia and developing slowly. Motion is first impaired and a considerable interval may elapse before sensation is affected. Motor impairment varies from mere mild paresis to complete paralysis, beginning as fatigue, loss of strength, and inability to stand. Unless the disease be located in the lumbar region the reflexes are exaggerated and muscle spasm is easily provoked or occurs without perceptible cause. As above noted the muscles become atrophied, and when the cord is seriously compromised are rigid in chronic spasm. The rectum and the bladder suffer finally, especially in disease of the lower segments. Occasionally in cases of high dorsal disease the arms will suffer more or less motor impairment. Sensory paralysis begins usually as paresthesia. In merely bedridden but not actually paralyzed individuals the reflexes should be normal. Of the muscle contractures, those of the psoas are the most common and distinctive. Paralysis follows rather than precedes deformity, and is noted in perhaps 20 per cent. of advanced cases. It should rarely occur if effectual treatment has been begun.