Spinal Tuberculosis

Overview of Spinal Tuberculosis in India

Spinal tuberculosis, or Pott's disease, is a dangerous and life-limiting type of tuberculosis affecting the bones in your spine. Although tuberculosis affects the lungs in many cases, it may also spread throughout your bloodstream, eventually settling in your bones, with the spine being the most affected bone in this case. Knowing about the types of spinal tuberculosis is important, as the exact location of the infection will determine the signs you'll experience, ranging from chronic pain in your back to neurological problems.

This condition may cause your bones in the spine to collapse, leading to deformities, such as kyphosis, and eventually paralysis if it is left undiagnosed. In this article, you'll learn more about the causes of spinal tuberculosis, discover all the types of spinal tuberculosis, learn about the symptoms they bring along, and find out how they are diagnosed and treated today.

What is Spinal Tuberculosis?

Spinal tuberculosis, or tuberculous spondylitis, also referred to as Pott's disease, is one of the many forms of TB that affect the vertebral column of the human body. Spinal TB is caused by the bacterium Mycobacterium tuberculosis, which is the same causative agent of TB in the lungs. In spinal TB, bacteria enter the vertebrae through the bloodstream from the lungs or other areas of the body.

Spinal TB causes the destruction of the vertebrae, resulting in severe pain, stiffness, and deformity of the spine. Spinal TB may lead to complications like paralysis if not managed promptly, because the affected person experiences compression of the spinal cord or nerves of the spine.

Types of Spinal Tuberculosis:

There are various types of spinal TB depending on the localisation and spread of the disease within the spine. Some of the types of spinal TB include the following:

Paradiscal TB

This is the most prevalent type of spinal TB. It is an infection that occurs in the vertebral bodies adjacent to the intervertebral disc. In paradiscal TB, the infection usually arises from the anterior aspect of the vertebral body and affects the adjacent vertebra, resulting in narrowing of the disc space and vertebral collapse.

Central TB

The infection usually starts in the central region of the vertebral body and causes collapse or "vertebra plana". There is no initial involvement of the intervertebral discs.

Anterior/Sub-ligamentous TB

Here, there is infection in the front portion of the vertebra, which progresses beneath the anterior longitudinal ligament. Here, the infection may extend across several vertebrae without much damage at the start, and this may result in the formation of large abscesses and spinal deformities.

Posterior TB

It is less common than the others, and it affects the posterior structures of the spine, such as pedicles, laminae, and spinous processes. This condition can cause posterior spinal abscesses and other neurological problems because of the close relation of the posterior structures of the vertebra with the spinal cord and nerves.

Non-Contiguous Skip Lesions

In this case, the lesion will occur in non-adjacent portions of the spine, in several separate regions.

Procedure:

Treatment of Spinal Tuberculosis (TB) is generally done with antitubercular drugs along with other treatments to relieve symptoms and avoid complications. Below is the summary of the treatment for spinal tuberculosis:

Antitubercular Drugs

Treatment of spinal TB involves the use of first-line antitubercular drugs. Treatment duration is usually for 6 to 12 months, depending upon the seriousness of the condition. The common drugs used for treatment include:

Isoniazid (INH)

Rifampicin (RIF)

Ethambutol (EMB)

Pyrazinamide (PZA)

Surgical Intervention

It is also possible that surgery will need to be done on your spine in order to fix some issues with Pott’s disease. Some surgical procedures may include the following:

Debridement: Removing infected or dead tissues in the area of the affected spine.

Drainage: Draining the accumulated pus in the form of abscesses in the spine.

Stabilisation and alignment: Tuberculosis can destroy the vertebrae. A surgeon might need to remove and repair any vertebrae and/or discs and place plates and screws in order to stabilise them.

Fusion: This process involves joining two vertebrae permanently together, limiting their mobility. The surgeon can use bone graft from other parts of your body in order to ensure that the vertebrae fuse together.

Supportive Care

Pain Management: The use of analgesic drugs and anti-inflammatory medicines helps in reducing the pain and discomfort.

Physical Therapy: Physical therapy for rehabilitation will help in improving movement, strengthening the back, and preventing other problems.

Orthotics Support: Devices that will help in stabilising the back and correcting spinal deformities.

Monitoring and Follow-Up

Regular monitoring using clinical assessments, imaging, and laboratory workups is important to evaluate the effectiveness of treatment as well as identify any possible complications that may arise. Moreover, adherence to medication regimens is key to prevent drug resistance and ensure success.

Management of Complications

Neurological Management: In case there are neurological deficits, other medications such as corticosteroids may be administered to decrease inflammation and improve neurological functioning.

Management of Abscesses: If there are paravertebral abscesses, then drainage of the abscesses might become necessary through surgery or percutaneously.