What Is Spinal Tuberculosis?
Spinal tuberculosis refers to a bacterial infection of the vertebrae and the intervertebral discs caused by the same bacteria that cause tuberculosis in the lungs. It is also referred to as the TB spine, Pott’s spine, or Kochs spine. The microorganisms usually get into the spine through the blood stream from infections somewhere else in the body, most commonly the lungs. They find their way into the bones and cause destruction and abscesses. In case nothing is done about the affected bone, the bone will eventually give in and squeeze against the spinal cord. Because it develops slowly, the disease is commonly mistaken for back pain for quite some time. On the bright side, spinal TB can be successfully cured if detected early enough.
Bone TB and Spine TB: Are They the Same?
Bones TB or bone tuberculosis occurs when a TB infection happens in any bone or joint, which includes hips, knees, ankles, and ribs. Spine TB is the most common form of bone TB, hence, the two terms become synonymous. This means that spine TB is a form of bones TB, but all bones TB is not spine TB. This is because bone TB symptoms and bone TB treatments are based on the same principles: long-term anti-tuberculosis drug treatment with surgical intervention only if necessary. Spine tuberculosis requires special consideration due to the proximity of the spinal cord. It is different from other spinal infections resulting from bacteria that have other behavior and treatment approaches.
Spinal Tuberculosis Symptoms
Spinal tuberculosis symptoms have a tendency to appear slowly and go unnoticed. The first symptom is normally chronic back pain that is increased at night and does not improve with rest. Some of the other spinal TB symptoms may be stiffness of the back, back muscles spasms, mild fever, night sweats, loss of appetite, weight loss, and fatigue. With time, patients may even develop a bulge on their spine due to its collapse. Bone tuberculosis symptoms may also occur even without having coughing fits. Where the infection is affecting the nerves or cord, numbness, tingling, weakness in the legs, problems in walking, and difficulty controlling urination or defecation can occur. Weakening of the legs is a warning sign that should not be overlooked.
What Causes Spinal TB?
The disease Spinal TB is caused by an organism called Mycobacterium Tuberculosis, which usually enters the blood circulation from the infected lungs or other body parts and settles in the spine.The disease can remain inactive for a long time with no symptoms at all of an infection. Individuals who are more vulnerable to tuberculosis include those that have low immunity due to HIV, diabetes, or malnutrition. It is also seen in individuals who have overcrowded surroundings or come in contact with an individual having active TB. It is also found in places with high prevalence of TB such as India.
Pott’s Paraplegia and Complications
The term “Paraplegia Pott’s” is used to refer to a condition marked by paralysis of the legs due to TB in the spine, which may occur due to either an abscess, infection, or a vertebra collapse leading to spinal cord compression. There is also the problem of collapse of the vertebra causing an arch in the spine. It also causes spinal deformity and abscesses that spread to the muscles. Pott’s paraplegia is treatable when there is early treatment. However, the delay could lead to permanent damage to nerves. That is why any leg weakness should not be neglected.
How Spinal TB Is Diagnosed
MRI is the most important investigation in diagnosing spinal tuberculosis since it reveals any changes first, including changes in discs and bones, abscess formation and cord compression. Bone changes are revealed through an X-ray, whereas CT scan helps in viewing the bony details. Blood investigations such as ESR and CRP indicate signs of inflammation, and biopsy helps in isolating the organism. The diagnosis is usually delayed by weeks or months due to the initial presentation of backache similar to normal back ache, so there must be a scan done on such night pain.
Spinal Tuberculosis Treatment
The spinal tuberculosis treatment involves mostly drugs, and people rarely need to undergo surgery.
Anti TB Medication
The basic principle behind TB spine treatment involves the use of anti-TB drugs on a daily basis for nine to twelve months. This has to be completed irrespective of whether there is an improvement in the condition, since stopping treatment midway can lead to a comeback as well as drug-resistant tuberculosis. Follow-ups and blood tests track the reaction and any potential side effects.
Bracing and Rest
The basic principle behind TB spine treatment involves the use of anti-TB drugs on a daily basis for nine to twelve months. This has to be completed irrespective of whether there is an improvement in the condition, since stopping treatment midway can lead to a comeback as well as drug-resistant tuberculosis. Follow-ups and blood tests track the reaction and any potential side effects.
Surgery
Only a small number of patients require surgery. Surgery is suggested for nerve or cord compression, instability of spine, deformity, abscess formation, or no relief with medicines. The surgeon removes all infected tissues and stabilises the spine through spinal fusion surgery. Spinal reconstruction surgery is used in case of very badly damaged vertebra. Dr. Zahir Abbas Merchant, who has been in practice for over 15 years in orthopaedics, recommends surgery only when really required.
When to See a Spine Doctor
See a spine expert if you suffer from back pain that lasts more than a few weeks, increased pain at night or along with fever, weight loss, and night sweats. Weakness of legs, tingling sensation, loss of bladder or bowel control requires immediate medical attention.
At The Spine eXpert in Mumbai, the group of professionals comprises Dr. Zahir Abbas Merchant, an orthopedic spine surgeon, having more than 15 years of experience in orthopedics. Dr. Merchant starts with the physical examination and interpretation of the MRI, X-Ray and Blood tests simultaneously in order to not confuse spinal tuberculosis with regular back pain. In most cases, anti-tuberculosis medicine is recommended along with bracing and follow-ups while surgical intervention is considered only if the spinal cord is being compressed or the spine is unstable.
Frequently Asked Questions
Is bone TB dangerous?
This disease may easily go unnoticed since, in infected bones, there is an erosion of bones, and for spinal TB, compression of the spinal cord is likely, resulting in paralysis. With proper medication of anti-TB drugs, however, many people have made complete recoveries.
Is spinal TB contagious?
Spinal TB is not contagious by itself, because the disease is within the bone and cannot be spread in the air. But some patients have TB in the lungs as well, which makes it contagious, and so a chest test is also done.
How long does spinal TB treatment take?
The duration of this therapy usually is between nine to twelve months but sometimes it might be more than that too. It depends on the reaction of the patient as to when the treatment will be stopped.
Can I walk with spinal TB?
It is possible for many individuals, particularly if done early during the onset of the condition, through a combination of the use of a brace and medical advice. In case you have weak, numb, and wobbly legs, see a physician immediately, since walking safely is dependent on the stability of your spine.
Can spinal tuberculosis be cured?
Absolutely. Spinal tuberculosis is treatable by means of an antitubercular drug treatment plan combined with surgery where necessary. For a consultation on this matter in Mumbai, the best person to approach is Dr. Zahir Abbas Merchant at The Spine eXpert Clinic. He has over 15 years of orthopedic experience.