Tuberculosis (TB) is basically an infectious disease that is caused by Mycobacterium tuberculosis that affects the lungs. However, this infection spread to other organs and tissues. When the infection spread to spines, it is called Spinal Tuberculosis. The spine is the most commonly affected site of skeletal tuberculosis. This disease is also known as Pott's disease.
Most commonly the disease affects people in their most productive stage i.e. between 10 to 30 years, although all age groups including children can get affected by spinal tuberculosis. The bacteria primarily affect the lungs and lymph nodes and get transferred to bones and joints through blood vessels.
According to research done on Spinal Tuberculosis in 2019, there were roughly 10 million cases of TB worldwide. Two-thirds of the cases of tuberculosis worldwide were spread among eight nations, with India leading the pack with 27% of all cases. (Garg et. al., 2019).
Types of Spinal TB
When the bacteria reach the spine, they establish 4 different types of lesions. A spinal lesion is an abnormal change caused by a disease or injury that affects tissues of the
Paradiskal: This is the most common type of skeletal lesion. The area between the two adjacent vertebrae is affected. The infection basically starts from the anterior inferior portion of the vertebral body which affects the lower part of one vertebra and the upper part of the other vertebrae. Later on, it spreads to the internal disk between the vertebrae after the whole vertebral end plates are affected.
Central: Central lesions result when the infection spreads to the vertebrae but not to the internal disk between the vertebrae. The whole vertebrae get infected in the later stage including the internal disc.
Anterior: This occurs beneath the anterior longitudinal ligaments (ALL) and involves the anterior margin of the vertebral column.
Posterior: This type of Tuberculosis is very rare and involves the posterior elements such as pedicles, laminae, transverse process, facet joints, and spinous process.
Symptoms of Spinal TB
Back Pain is the earliest and most common symptom of Tuberculosis. The patient may also complain of stiffness, swelling, deformity, paraparesis with low-grade fever, evening rice of temperate, anorexia, or weight loss.
If the back pain gets worsens with time and the patient may face extreme difficulty in standing or walking, discomfort in sitting, weakness, and stiffness. Other spinal TB symptoms include tenderness in the backbone, spinal deformity, muscle spasms, the restricted motion of the spine, and also neurological deficits.
Apart from this, spinal TB can result in neurological problems such as reduced sensation, nerve root discomfort, and paralysis of both legs.
Diagnosis of Spinal TB
The orthopedic surgeon may ask for a thorough history of previous disease and physical examination, symptoms, and problems faced by the patients. Apart from this, the orthopedic surgeon may suggest some tests which help in the diagnosis of tuberculosis. These tests are:
Blood test: Blood tests shows low hemoglobin, increased Total Leucocyte Count (TLC), and elevated ESR.
X-Ray: As the spinal TB begins with the loss of disc space, an x-ray will show the reduced height in the early phases of the disease. Also, 30-40% of Calcium is lost after 2-4 months which shows up as a radiolucent area on the X-ray.
CT Scan: It helps in assessing the extent of destruction of the vertebral body. Shape, extent, and route of spread of the disease can be very well visualized on CT Scan.
MRI: It provides an earlier diagnosis and is the investigation of choices as it can additionally evaluate the status of the spinal cord.
Biopsy: It is required only in doubtful diagnoses. If the infection is visible in the MRI, doctors may advise a biopsy test to further evaluate the infection. The biopsy will give the final confirmation of the infection.
Treatment of Spinal TB
Although the chances of developing spinal TB are low (1–3%), the condition is life-threatening once it is identified. It might worsen if left untreated for a prolonged period of time. Spinal TB can be treated by various methods which include:
Chemotherapy: Anti-tubercular therapy (ATT) is the main way of treating patients with TB. Same drugs, as per WHO’s suggested, short regimens are used.
Bed Rest and Traction: Along with medication, absolute bed rest is required for pain relief and to prevent further collapse of the vertebral column, pathological dislocation, and neurological complications.
Mobilization: Gradual mobilization is encouraged with the help of a spinal brace as soon as the patient is comfortable.
Surgery: When the spine is deformed, surgery is frequently advised. Surgery is only advised when patients do not respond to a minimum of 3 weeks of ATT. The surgery is performed to remove the diseased portion of the vertebral body and tuberculous puss. It is suggested to remove lesions, correct abnormalities, support the spine, and relieve pressure on the spinal cord.
Prevention of Spinal TB Tuberculosis
The treatment of spinal TB may take 9 to 14 months to heal. The spinal damage starts to heal and the tissues of the vertebral column start recovering. The X-ray or MRI may show the healing of spinal TB.
Complications of Spinal TB
If not treated early or properly, spinal TB could be life-threatening. The longer you wait for getting treated, the worse it becomes. Some of the complications include:
- Vertebral collapse causing your back to curve or bend. (kyphosis)
- Compression of the vertebral column.
- Severe infection in other organs too.
- Several neurological problems.
- Paralysis can occur in both legs.
If diagnosed and treated early, Spinal TB is curable. Patients must remember to regularly take medicines on time and go for regular checkups with their doctor.
The patients diagnosed with spinal TB starts experiencing
- Severe back pain
- Difficult in standing straight
- Tenderness in the backbone
- Muscle spasms
- Deformity in the spinal cord.
Light food is advised for spinal TB such as porridge, khichdi, soybean, milk, and fruits & vegetables rich in Vitamin A, Vitamin C, and Vitamin E which includes, orange, mango, guava, carrot, amla, tomato, etc.
If not diagnosed and treated early, Spinal TB can cause paralysis in the lower parts of the body.
The early symptoms of spinal TB include pain, weakness, and numbness in the backbone and limbs. Along with this, some common symptoms include high fever, night sweats, weakness, and weight loss.
Spinal TB medication is recommended for at least 9 to 14 months, which can be increased or decreased depending upon the severity of your condition. On average, patients start to show improvement after 9 months of medication.
If diagnosed early, Spinal TB can be cured with the help of medication only. Most patients, who regularly take their medicines for 9 to 14 months can be cured completely from spinal TB without surgery.