Tuberculosis of Spine - Pott Spine

Tuberculosis is an infectious disease which usually affects the lungs but may attack any part of the body and caused by bacteria tuberculosis bacillus or Mycobacterium tuberculosis. Tuberculosis of spine is also called as Pott Spine or Tuberculosis Spondylitis.

Tuberculosis of spine is most commonly seen disease of spine in India but it is rarely seen in the developed countries. Usually TB bacteria spreads from the primary lesion or reactivated lesion. For example - If a person suffers from lung tuberculosis and he has been treated well for the lung TB, hence his symptoms remain dormant for a long time. During this dormant period bacteria may spread to other part of body like spine and vertebrae and stay dormant for years. Hence the symptoms are not seen at that time but they appear later. The early diagnosis of disease is necessary otherwise the bacteria may affect the spine in such a way that spine becomes deformed leading to defective curvature of spine (kyphosis).

Sign and Symptoms

• Back Pain is the most earliest symptoms. Back pain remains for weeks.
• low or high grade fever, weight loss, loss of appetite and weakness present alongwith back pain.
• Spine- stiff and painful with tenderness on touch. Muscle spasm around the spine present.
• If the diagnosis is delayed then the spine and vertebral bones cam be destructed leading to deformed spine known as kyphosis.
• Cold abscess- Abscess formation in and around the spine can lead to narrowing of spine and ultimately leads to damage of nerve which passes through the spine.
• Neurological damage or nerve damage can lead to partial or complete paralysis of the part.
• Cauda Equina Syndrome - It is a neurological disease caused by narrowing of spinal canal and compression of nerve root leading to loss of function of the part with weakness of the muscle.

Diagnosis

• Microbiology study - The sample of abscess or pus from bone tissue is taken and looked microscopically for acid fast bacilli(AFB). If AFB is present then it is confirm of TB.
• CT scan of affected part - CT scan helps to guide the level of spread of infection in the bone and soft tissues. It guides effectively in the early stage of lesion and bony lesions.
• MRI - MRI helps to understand if the nerve is compressed or affected in any way due to TB. Also will be helpful to know whether the infection has spread to other soft tissues or not.
• Blood test - ESR levels are high which indicate presence of Tuberculosis.

Treatment

• Anti-tubercular therapy is indicated
• If the pus or abscess is not settled with the anti -tubercular drugs then surgery is the option.
• Surgery is required if there is nerve damage or nerve compression. Surgery is the only option so that the compression of nerve is released and avoid the further complications like paralysis.
• TB spine is commonly seen with HIV infection. In such cases along with anti-tubercular therapy , anti-retroviral therapy is also given.

Post-operative and during treatment care

• Care of Kyphosis - Kyphosis is the deformity of spine due to destruction of vertebrae or spine. Curvature of spine occurs which causes bowing of back. If kyphosis occurs in childhood it is advised to go for correction surgery. Physical therapy and braces can be useful to avoid further complications and to reduce the pain due to deformity.
• Nerve damage - If the disease is not treated or if kyphosis is severe then nerve damage is very likely to occur. Physical therapy can be useful to some extend if the paralysis is present.