Tuberculosis of the spine, known as Pott’s disease, is a treatable form of tuberculosis affecting the vertebrae. This extrapulmonary condition means the infection extends beyond the lungs. Without prompt treatment, it can severely damage the spinal column.
Understanding Spinal Tuberculosis
Spinal tuberculosis develops when Mycobacterium tuberculosis bacteria spread from an initial infection site, most often the lungs, to the spinal column. This spread occurs through the bloodstream, a process called hematogenous dissemination. Once the bacteria reach the vertebrae, they can cause bone infection (osteomyelitis) and joint inflammation (infective arthritis).
The infection commonly targets the front part of the vertebral body. From there, it can extend to adjacent vertebrae and the intervertebral discs. The infection can lead to bone tissue destruction, causing vertebrae to narrow and potentially collapse.
Recognizing the Symptoms
Recognizing spinal tuberculosis symptoms can be challenging due to their gradual and nonspecific onset. Persistent, localized back pain is often the earliest and most common symptom, worsening with activity and potentially radiating. Patients frequently experience back stiffness, particularly in the morning or after inactivity, and may assume a protective posture.
Beyond localized pain, systemic symptoms common to tuberculosis may also occur, including low-grade fever, night sweats, unexplained weight loss, and malaise. If the infection progresses and compresses the spinal cord or nerves, neurological symptoms can develop. These may include numbness, tingling, limb weakness, or, in severe cases, paralysis. Advanced stages can also lead to spinal deformities, such as kyphosis, often called a “hunchback,” due to vertebral collapse.
Diagnosing Spinal Tuberculosis
Diagnosing spinal tuberculosis involves a comprehensive approach combining physical examination, imaging, and laboratory tests. A healthcare professional will assess back pain, stiffness, and neurological deficits, identifying areas of tenderness or swelling like paravertebral abscesses.
Imaging studies are essential for diagnosis, showing spinal damage. X-rays can reveal vertebral narrowing and collapse, while MRI or CT scans visualize bone destruction, abscess formation, and spinal cord compression. Blood tests, such as erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), may indicate inflammation, though they are not specific to tuberculosis. A definitive diagnosis often requires a biopsy of the affected spinal tissue for bacterial culture, histopathology, or molecular confirmation to identify Mycobacterium tuberculosis.
Treatment and Managing Recovery
The primary treatment for spinal tuberculosis involves a prolonged course of anti-tuberculosis medications. This includes a combination of drugs like isoniazid, rifampicin, pyrazinamide, and ethambutol, administered for 6 to 18 months. Adherence to this multi-drug regimen is essential to eradicate the bacteria and prevent drug resistance. Regular follow-up appointments are necessary to monitor treatment effectiveness and manage potential side effects.
Supportive care, including pain management through analgesics and physical therapy, is important for recovery, improving mobility and reducing discomfort. Immobilization of the affected spinal region, often with external bracing, may also be recommended for stability and healing. Surgical intervention is considered for severe spinal deformity, significant neurological deficits (like paralysis), or large abscesses unresponsive to medication. It may involve debridement (removing damaged tissue), abscess drainage, or stabilization procedures like fusion to join vertebrae and prevent further damage. The goal is to alleviate spinal cord compression, correct deformities, and improve spinal stability to prevent long-term disability.