Spinal Tuberculosis ( Potts Spine )
Tuberculosis is a common health problem in India. Tuberculosis is a highly communicable disease caused by the Mycobacterium tuberculosis. Tuberculosis (TB) is most common in developing countries and death because of TB is one among the top-10 causes of death worldwide .Tuberculosis(TB) is mainly of two types: Pulmonary and Extrapulmonary Tuberculosis. Pulmonary TB is TB involving lungs and extrapulmonary tuberculosis is tuberculosis involving any part of the body other than lungs. Around 15% of patients with pulmonary tuberculosis will have extrapulmonary involvement. Spinal Tuberculosis is a skeletal( bony) form of extrapulmonary tuberculosis. There is a huge misconception that tuberculosis affects only the lungs. But fact is, that, tuberculosis can spread through the bloodstream to different parts of the body such as lymph nodes, brain, bones, spine. Tuberculosis of Spine is also called Pott disease. It mainly affects children and young adults. Spinal tuberculosis can occur anywhere in the spine.Most commonly seen in thoracic spine
What are the predisposing factors?
Predisposing factors for spinal tuberculosis are poverty, overcrowding, malnutrition, illiteracy, addictions such as alcohol and drug abuse, immunosuppressive disorders such as diabetes mellitus and HIV infection etc. Increased awareness in society is essential to control it in the early stages through appropriate treatment
What is Spinal TB?
Spinal TB is a destructive form of disease in which progressive bone destruction leads to vertebral collapse.Multiple vertebrae can be involved and can be rapidly destroyed leading to collapse of bony structure and kyphotic deformity. This will lead to severe cord compression and stretching resulting in paralysis of both the lower limbs. It also causes cold abscess formation when infection reaches adjacent ligaments and soft tissues. Further it causes spinal canal narrowing due to abscess, granulation tissue, direct dural invasion resulting in spinal cord compression and neurologic deficit.
A few decades back, spinal tuberculosis was a dreaful disease. It is not so, anymore. With advancements in the medical field, when diagnosed in the early stages, a complete cure is possible.
In the early stages of the disease,use of antitubercular medications is sufficient for complete cure. However in severe cases and in patients who have weakness or paralysis of legs,surgical decompression of spinal cord along with antitubercular medications is necessary.
Surgery removes the pressure effect on the spinal cord,prevents the progression of the deformity and gives good relief of pain. Implants made of titanium and bone grafts are used to stabilize the spine while the healing process ensues
What does Spinal TB look like ( Symptoms) ?:
- ✯ Back pain
- ✯ Restriction of movements of spine
- ✯ Previous history of cough
- ✯ Constitutional symptoms ( Malaise, loss of apetite,loss of weight,Evening rise of temeperature ,night sweats,).These constitutional symptoms can be absent in patients with good nutrition
- ✯ With progression of the disease ,collapse of the spine is evident with prominent spinous process and sharp deformity
- ✯ In the later stages or severe disease,results in kyphotic deformity
- ✯ Abscess formation ( Cold Abscess) in the paraspinal area, groin and loin, and sinuses.
- ✯ Pus and deformity causes pressure on the spinal cord resulting in paralysis
- ✯ Neurological involvement initially presents as incordination, clumsiness while walking and slowly progresses to paralysis
How is Spinal Tuberculosis diagnosed:
- ✯ Chest X-ray (to examine the lungs)
- ✯ Sputum cultures (to detect the presence of bacteria)
- ✯ Blood culture
- ✯ Tissue biopsy
- ✯ Mantoux Tuberculin skin test
- ✯ TB Gene Expert
Blood tests:
- ✯ ESR is markedly elevated ( > 70 mm/hr).Serial ESR measurements help in assessing the response to treatment .
- ✯ White blood cell counts ( WBC) are raised with increase in lymphocytes
X rays: X rays are helpful to assess the bony destruction ,deformity
CT scan : Useful in assessing the exact destruction of bony elements .Ct is also useful in assessing junctional areas like craniovertebral ,cervicodorsal regions.
MRI: MRI is the gold standard for the diagnosis. It demonstrates the extension of the disease ,soft tissue involvement, spread of the abscess and cord compression
How is spinal TB treated :
General supportive measures including bed rest, bracing, nutritious diet, vitamins as required, care of the bladder and bowel, good nursing care
SPINAL TUBERCULOSIS IS CONSIDERED AS A MEDICAL DISEASE WITH SELECTED SURGICAL INDICATIONS
MODERN ANTI TB DRUGS ARE ABLE TO ACHIEVE EXCELLENT CLINICAL CARE.
In the initial period all the patients are given multidrug chemotherapy and bed rest with external bracing .All the patients are carefully followed till complete healing
The currently recommended first-line drug regime is four-drug therapy. This includes Isoniazid 5 mg/kg, Rifampicin 10 mg/kg, Pyrazinamide 20 – 25 mg/kg, and Ethambutol 15 mg/kg for two to three months followed by Isoniazid and Rifampicin for four to six months.
Indications for surgery in Spinal TB: Surgical treatment is recommended for certain specific indications like the extensive neurological deficit, severe pain, instability, deformity of the spine and lack of expected response to medications.
The aims of surgery in spinal tuberculosis are to obtain a tissue sample for biopsy, drain an abscess cavity, achieve debridement of disease focus and to stabilise the spine.
Tuberculosis of the spine is preventable and treatable. Early diagnosis and management of spinal tuberculosis is very important to prevent serious complications.
Success rate of surgery in spinal tuberculosis is remarkably high.
Spinal TB is curable. No need to fear. Contact your doctor.
