Characteristics of Spine Tuberculosis
- Location: Most commonly affected area is lower thoracic (T10) and upper lumbar vertebrae (L1)
- Infection source is usually outside the spine and spread from the lungs via the blood.
- There is a combination of osteomyelitis and infective arthritis.
- Involvement of more than one vertebra causes disc collapse and spinal damage
Risk factors of Spine tuberculosis
Following individuals are at higher risk of getting spine tuberculosis:
- HIV infection
- Alcoholism
- Undernourished
- Elderly
- Patients after gastrectomy for peptic ulcer
- Endemic tuberculosis
- Poor socio-economic conditions
Cause of Spine Tuberculosis
Mycobacterium tuberculosis is the causative organism of tuberculosis and when the infection spreads from lungs to the spine, Pott’s Disease or tuberculosis of spine occurs.
Symptoms of Spine Tuberculosis
Tuberculosis of spine or Pott’s disease present following symptoms in the patient:
- Gradual onset of localised back pain
- Fever
- Night sweats
- Anorexia
- Progressive weight loss
- Kyphosis
- Paravertebral swelling
- Patient always in a protective upright, stiff position
- Difficulty standing
- Numbness or weakness in the legs
- A psoas abscess may present as a lump in the groin and resemble a hernia
- Presence of complications such as neurologic deficits, abscesses, or sinus tracts
Diagnosis of Spine Tuberculosis
A thorough history of the patient along with physical and neurological examination plays most important role in forming the basis for further investigations to diagnose spine tuberculosis. The investigations include:
- Blood ESR
- Mantoux skin test
- Spinal X-ray
- Chest X-Ray
- MRI scanning
- CT scans
- Nuclear bone scans
- A needle biopsy of bone or synovial tissue
Management of Spine Tuberculosis
Spine tuberculosis needs prompt treatment that includes the following:
- Anti-tubercular drug therapy for 6 or more months
- Chemotherapy
- External bracing
- Surgical intervention like anterior spinal fusion, anterior decompression, posterior shortening, posterior instrumented stabilisation and anterior and posterior bone grafting
- Immobilisation of the spine for two or three months
