Spinal
Tuberculosis
Lecture By: M.K Sastry
Program Director,
Post Graduate Studies
& PhD Program
What Is Spinal Tuberculosis?
• Tuberculosis of the spine, also known as
tuberculous spondylitis or Pott's Disease,
is a is an infection of the spine by the
Mycobacterium tuberculosis bacterium (TB).
• It usually infects another area of the body first
before moving into the spine.
• Spinal tuberculosis is rare in industrialized countries
but still common in developing nations.
• It can cause permanent neurological problems and
severe spinal deformities, but it can be controlled in
most cases.
Symptoms
• Some of the most common symptoms of Pott's
Disease are:
– Back pain
– Fever
– Night sweats
– Anorexia
• This leads to a significant, unhealthy weight-loss.
• The back pain is sometimes so painful patients will
develop a mass in the spine which can cause:
– Tingling
– Numbness
– Weakness in the legs
– The deterioration and back pain will cause the sufferer to sit
and walk in a rigid, upright manner.
Causes
• Pott's Disease, like other forms of TB, is
caused by a mycobacterium which is spread
by way of blood or breathing droplets from
an infected person into your lungs where
the bacteria will thrive and grow if not killed
by your immune system.
• Once in your blood stream, tuberculosis can
infect a number of organs, each with their
own set of symptoms and complications.
Diagnosis
• Tuberculosis causes the disks in the spine to die
and break down, which often leads to the
narrowing of the vertebra and the eventual
collapse of the spine.
• Radiographs and CT scans of the spine are
sometimes able to show tuberculosis of the spine,
if present, a bone biopsy will be done for
confirmation.
• A test is often performed to check a patient's
Enthrocyte Sedimentation Rate; a high ESR is a
sign of Pott's Disease.
• TB skin tests can also determine if there is a
presence of tuberculosis in the body.
How to Treat Spinal TB?
Instructions
1. Administer a combination of 4. Continue antibiotic therapy for six to
chemotherapy with at least three nine months in patients without
antituberculous drugs. A four drug
cervical lesions, major neurologic
regimen should be used empirically in
areas with less than a 4 percent resistance
involvement or multiple vertebral
to isonicotinic acid hydrazide (INH). involvement. These patients are
candidates for surgery and may
2. Adjust the treatment as local susceptibility require a shorter period of
changes. INH and rifampin should be chemotherapy.
administered during the entire treatment.
5. Consider surgery to correct spinal
3. Provide additional medication during the deformities. The reconstruction
first two months of therapy. These usually method used depends on the extent
include first line drugs like ethambutol, of bone destruction and the level of
pyrazinamide and streptomycin. A three
drug regimen usually includes INH,
the vertebral spine involved. The
rifampin and pyrazinamide. An additional most conventional approaches
second line drug should be used in cases include anterior radical debridement
of drug resistance. and posterior stabilization with
instruments.
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