TUBERCULOSIS OF THE SPINE
CAUSE
- Spinal Tuberculosis (Pott’s Disease) is caused by the bacteria Mycobacterium Tuberculosis, in which the spinal column is affected.
- It is called tuberculosis spondylitis and the original name was formed after Percivall Pott, a London surgeon.
- It is most common during the first three decades of life, though the disease may occur at any age between 1-80 years.
- It is a presentation of extra-pulmonary tuberculosis that affects the spine.
- Bone and joint TB accounts for up to 35% of cases of extra-pulmonary TB.
- Most commonly, it affects the thoracic and thoraco-lumber spine.
- Skeletal TB most often involves the spine, followed by tuberculosis arthritis in weight-bearing joints and extra-spinal tuberculous osteomyelitis.
- In the spine, the bacterium usually gets lodged within the vertebral body, and causes an inflammatory reaction initially.
- Progressive infection causes destruction of bone and the supporting structures with collapse and fracture of the vertebrae and formation of pus within and adjacent to the spinal column.
- There is loss of disc height and soft tissue swelling of the vertebrae.
- Abscesses and tissue formation can narrow the spinal canal, leading to neurological damage.
- This, in turn, results in the compression of the spinal nerves and may cause complete paralysis of both legs, and rarely, upper limbs.
- This health condition is irreversible, even with good surgical treatment.
SYMPTOMS
- Localised back pain
- Painful movements in the early stages
- Fever, weight loss and loss of appetite
- Later, the patient may develop a hunch back or weakness in the hands or legs.
- The deformity varies in each patient, delaying the diagnosis in early stages.
PREVENTION AND CURE
- The challenge is on early detection of spinal TB through its symptoms.
- X-rays in the early stages may be normal.
- MRI scans pick up the infection long before we see it on X-rays.
- The definitive diagnostic test is pathological / microbiological examination of disease tissue obtained from the site of lesion (wound).
- Blood test, X-rays, MRI scan and biopsy aid diagnosis.
- Early diagnosis, followed by prompt and adequate treatment, can completely cure spinal TB.
- In neglected cases, the patient may develop angular deformity due to destruction of vertebral bodies called kyphosis.
- Treatment options include antibiotics and corrective spin surgeries.
- Taking anti-TB medication religiously is effective in control of the disease.
- A brace is used to protect the spine during the treatment period.
- Improper or inadequate treatment with medicines can aggravate the problem by creating drug-resistant bacteria which may be very difficult to treat.
- Nowadays, there is an increasing trend of spine TB in view of irregular medical management, emergence of resistant strains and low immunity in patients to chemotherapy, steroids or surge in patients of HIV.
- Patients who do not respond to medical treatment, and those who develop neurological deficit in spite of treatment, need surgery.
- Surgery involves drainage of inflammation area and stabilization using bone graft or implants.