Spinal Tuberculosis: The Indian Scourge! [Tuberculosis Awareness Month]
Migration to cities, urban homelessness, increased pollution, increased stress and the rise in HIV has led to a global resurgence of tuberculosis. Almost 10 million Indians suffer from tuberculosis. Although tuberculosis commonly affects the lungs, nearly 2,00,000 Indians suffer from tuberculosis of the spine. Today in a quest to observe Tuberculosis Awareness Month, we have detailed out for you the complications, risk factors and related information on spinal tuberculosis – one of oldest diseases affecting mankind since Neolithic times. Spinal tuberculosis was one of the leading causes of mortality in the 20th century.
Understanding Spinal Tuberculosis. In the spine, the germ, mycobacterium tuberculosis usually gets lodged within the vertebral body. Initially, the organism causes an inflammatory reaction. Progressive infection causes destruction of bone and the supporting structures with collapse and fracture of the vertebrae and formation of pus within and adjacent to the spinal column. This in turn results in compression of the spinal nerves and may cause paralysis of hands or legs.
Early Stages of Spinal Tuberculosis. In the early stages, the patient experiences back pain and painful movements. Fever, weight loss, loss of appetite may be present. Later the patient may develop a deformity of a hunch back or weakness in the hands or legs. However the deformity varies in each patient and hence diagnosis may be difficult especially in the early stages.
X-rays in the early stages may be normal. MRI scans pick up the infection long before we see it on X-rays. The only definitive diagnostic test is pathological / microbiological examination of disease tissue obtained from the site of lesion (wound).
Diagnosis of Spinal Tuberculosis. Early diagnosis of the disease followed by prompt and adequate treatment can completely cure spinal tuberculosis. The aims of treatment of spinal tuberculosis are:
- To cure the infection
- To relieve the patient`s severe pain
- To prevent spinal deformity & restore normal spinal alignment
- To prevent / cure neurological deficits
Treatment of Spinal Tuberculosis. Antibiotics form the mainstay of treatment of Spinal tuberculosis. It is vital to adhere strictly to the regimen prescribed by the doctor to achieve the best results. Skipping therapy can only result in worsening of the problem but may also result in drug resistance.
Surgery is indicated only in about 20% cases. Primarily the indications for surgery include:
- Weakness in the hands / legs
- Spinal deformity due to severe vertebral destruction
- Superficial swelling
- Persistent pain / progressive disease in spite of adequate trial of medications
Modern surgery procedures such as minimally invasive spine surgery (MISS) for spinal tuberculosis are quite safe and in a proper set-up has consistently excellent results. The type of surgery may range from ultrasound / CT guided drainage of paravertebral abscess to clearance of the dead and diseased tissue with conventional or endoscopic techniques. In patients with paralysis, surgery involves removal of pressure on the spinal cord and in patients with deformity or instability, spinal stabilization is also required.
This post was complied with expert inputs from Dr. Gautam Zaveri, Consultant Spine Surgeon, Jaslok, Fortis & Joy Hospital, Mumbai.
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