Spinal Tuberculosis (Pott's Spine)

Spinal tuberculosis is an infection of the spine caused by the same germ that causes lung TB. It usually affects the vertebrae and discs of the mid and lower back, and if untreated it can damage the bones, causing collapse, a hump, pus collections and pressure on the spinal cord. It is common in India, and with early diagnosis and a complete course of anti-TB treatment, most patients can be treated without surgery.

Symptoms

• Persistent back pain that often worsens at night and does not settle with rest
• Low-grade fever, especially in the evenings, and night sweats
• Loss of appetite, weight loss and tiredness
• A visible hump or sharp bend in the back
• Swelling in the back, groin or thigh due to a collection of pus (cold abscess)
• In advanced cases, weakness or numbness of the legs and bladder problems

Causes

Spinal TB is caused by the tuberculosis bacteria, which usually reach the spine through the bloodstream from an infection elsewhere in the body, such as the lungs or lymph glands. Risk is higher with close contact with a TB patient, poor nutrition, diabetes, HIV infection, kidney disease, medicines that lower immunity and crowded living conditions. Spinal TB on its own is not usually passed to others, but family members should be checked if lung TB is also present.

Diagnosis

An MRI of the spine can detect the infection early and shows any pus collection or pressure on the spinal cord. X-rays and CT scans show the extent of bone damage, and a chest X-ray and blood tests are also done. Wherever possible, the diagnosis is confirmed by testing a sample taken with a CT-guided needle biopsy or during surgery. This sample is checked with rapid molecular tests, culture and tissue examination, which also help rule out other infections or tumours and detect drug-resistant TB.

Treatment

Anti-TB medicines are the mainstay of treatment. A combination of medicines is taken daily for many months, usually longer than for lung TB, as advised by your doctor. It is very important not to stop the medicines early, even when you feel better, as this can lead to relapse and drug resistance. Free treatment is available under the government TB programme. Good nutrition, a back brace, physiotherapy and regular tests to monitor progress and side effects are also important.

Surgery is needed only for specific situations: weakness of the legs that is worsening or not improving with medicines, severe or increasing deformity, an unstable spine, a large abscess, poor response to treatment, or when a tissue sample is needed for diagnosis. The operation removes the infected tissue and pus, relieves pressure on the spinal cord and, where needed, stabilises the spine with screws, rods and bone graft. Anti-TB medicines continue after surgery.

When to Seek Urgent Care

Go to the nearest emergency immediately if you notice:

• New or worsening weakness in the legs, or difficulty walking
• Difficulty passing urine, or loss of bladder or bowel control
• Yellow eyes or skin, persistent vomiting, a severe rash or change in vision while taking TB medicines

If you have long-standing back pain with fever or weight loss, or have been diagnosed with spinal TB, please consult Dr. Prashant Sharma at Keshav Super Speciality Hospital, Meerut, for evaluation and guidance.

Related Conditions

• Sciatica
• Back Pain (Backache)
• Neck Pain
• Cervical Pain
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