. Orthopaedic surgery for students and general practitioners : preliminary considerations and diseases of the spine : 114 original illustrations. or cavity, or, as it is sometimes called, acavernous excavation in the bone. In the osseous detritusone may find gritty remains of necrotic trabeculse or evensplinter-like fragments, which when large may deserve thename sequestra but these are not the rule. (Fig. 23.) The transverse, articular and spinous processes are rarelyaffected as they are covered with hard bone, while the bodiesare composed of more spongy bone, which are attackedusually in the
. Orthopaedic surgery for students and general practitioners : preliminary considerations and diseases of the spine : 114 original illustrations. or cavity, or, as it is sometimes called, acavernous excavation in the bone. In the osseous detritusone may find gritty remains of necrotic trabeculse or evensplinter-like fragments, which when large may deserve thename sequestra but these are not the rule. (Fig. 23.) The transverse, articular and spinous processes are rarelyaffected as they are covered with hard bone, while the bodiesare composed of more spongy bone, which are attackedusually in their anterior portions, softened and disinte-grated. As the disease extends to the periphery of onevertebral body, the contiguous surfaces of the adjacent TUBERCULAR LESIONS OF THE SPINE. 71 vertebrae and intervertebral discs become involved in thetuberculous process. Some hold that the intervertebralcartilages are first involved; this may be so, but it is certainlynot the rule. In any case, where the disease is of any extent,the intervertebral cartilages are absorbed only at the pointof the disease. It is not an articular disease, Fig. 23. Sagittal Section of a Carious Vertebral Body, Showing AbscessCavity at a. (Courtesy of Dr. Holmes Smith.) Primary disease at two points not adjacent is rare, thoughreported. (Fig. 24.) Superficial osteitis, not causing de-formity and absorption of the intervertebral discs, is alsorare. Pus formation may be characteristic of certain cases andis usually indicative either of extensive disease or of an active 72 ORTHOPEDIC SUEGERY. process or possibly in certain cases to secondary infectionwith pyogenic cocci. Pus naturally gravitates downward,hence the frequency of psoas abscess in lower spinal abscess may point into the pharynx as a post-pharyn-geal abscess, into the neck, back, axilla, lungs, abdomen,groin, etc., depending on the situation of the lesion and thehne of least resistance. The abscess in the bone we mayspeak of a
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