Tuberculosis is a common health problem in India. Tuberculosis is mainly divided into two types: Pulmonary and Extrapulmonary Tuberculosis. Pulmonary is involving lLungs and extrapulmonary tuberculosis is tTuberculosis involving any part of the body other than lungs. Spinal Tuberculosis is a skeletal form of extrapulmonary tuberculosis. There is a huge misconception that tTuberculosis affects only the lungs. But fact is, that, but tuberculosis can spread through the bloodstream to different parts of the body such as lymph nodes, brain, bones, spine. Tuberculosis of sSpine is also called Pott disease. In dDeveloping cCountries, occurrence of sSpinal tTuberculosis is increasing. It mainly affects children and young adults.
Predisposing factors for spinal tuberculosis are poverty, overcrowding, malnutrition, illiteracy, addictions such as alcohol and drug abuse, immunosuppressive disorders such as diabetes mellitus and HIV infection etc. Increased awareness in society is essential to control it in the early stages through appropriate treatment.
What is Spinal TB?
Spinal TB is a destructive form of disease in which progressive bone destruction leads to vertebral collapse and Kyphosis, i.e., forward rounding of the back. It also causes cold abscess formation when infection reaches adjacent ligaments and soft tissues. Further it causes spinal canal narrowing due to abscess, granulation tissue, direct dural invasion resulting in spinal cord compression and neurologic deficit.
Symptoms:
Common symptoms of sSpinal TB are mild to severe bBack pain, nNeck pain, tenderness, muscle spasms, fever, weight loss, stiffness in muscles etc. In some cases, compression of nerves results in paralysis and muscle weakness. In late stages, progressive destruction of bone leads to a condition called Kyphosis in which forward rounding of the back occurs. Kyphosis leads to gibbus formation on the back.
Image showing Kyphosis of spine. (fForward rounding of back). Spinal TB is the common cause of Kyphosis. Kyphosis at the dorsolumbar region in later stages results in alteration of neurological function. It can leads to paralysis of lower limbs (Paraplegia) or paralysis of all four limbs (Quadriplegia).
Diagnosis:
If spinal TB is diagnosed in the early stages, it can be cured only with medicines alone. 95% of the patients get cured without surgical intervention.
Early diagnosis is needed to prevent permanent neurological disability and to minimize spinal deformity. Erythrocyte Sedimentation Rate (ESR) is the most helpful test in diagnosis of spinal tuberculosis.
Biopsy offrom the affected site is the gold standard technique to rule out risk of cancer and some infections in spinal TB. Biopsy culture test and TB GeneXpert test help in accurate diagnosis of MultiDrug Resistant Tuberculosis or MDRTB
Computed Tomography (CT) is done to access bone involvement. Magnetic Resonance Imaging (MRI) is required to evaluate soft tissue involvement and abscess formation.
Treatment:
If spinal TB is diagnosed early, it can be treated with a standard four-drug regimen. These medicines are prescribed for the duration of 1 year and under a physician’s supervision the dose is tapered gradually. In 95% of cases medicines work well and patients get back to normal life. Complications of spinal tuberculosis due to late diagnosis and management are spinal deformity and paralysis of lower limbs. Patients should be closely monitored for progression of deformity.
If a patient is diagnosedcomes in the later stages of disease like whenif the patient is unable to walk, bed ridden or developed kyphosis or cold abscess; then surgery is advised. In case of paralysis of legs or all four limbs, then only surgery is the optionchoice of treatment. In surgery, pus is drained and stability of the spine is achieved through implants. Patients without paralysis can stand the next day after surgery and get discharged from hospital in 3-4 days. Before discharge home exercise regimen is advised for patients; follow -up at regular intervals is planned. Rehabilitation programs play a key role in patients undergoing surgery. Patients who have developed paralysis will take time up to 6 months to recover depending on severity of TB.”
Summary:
Spinal tuberculosis is also known as Pott’s disease. It is a skeletal form of extra-pulmonary tuberculosis.
It is a destructive form of tuberculosis in which progressive bone destruction leads to vertebral collapse and Kyphosis.
Its main symptoms are back pain, neck pain, stiffness, tenderness, muscle spasm, weight loss.
In later stages, bone destruction leads to cold abscess formation and Gibbus formation.
ESR, Biopsy culture test and TB GeneXpert test are some diagnostic tests in spinal tuberculosis.
If Spinal TB is diagnosed early, it can be treated with a standard four-drug regimen.
In later stages of disease surgery is performed to drain the abscess, to stabilize the spine and to treat any neurological deficit.
Success rate of surgery in spinal tuberculosis is remarkably high.
