This entity was first described by Percivall Pott. He noted this as a painful kyphotic deformity of the spine associated with paraplegia. Since then condition is often referred to as Pott’s disease.
The spine is the most common site of skeletal tuberculosis accounts for 50 percent of the cases. Lower thoracic region is the most common segment involved followed by lumbar, upper dorsal, cervical and sacral regionsin decreasing order of frequency.
In the past, tuberculous spondylitis used to be a disease of early childhood. But with improved public health measures, this age incidence has changed, and adults are more frequently affected.
Pathology
Focus of infection usually begins in the cancellous bone of the vertebral body. Occasionally it is in the posterior neural arch, transverse process, or subperiosteally deep to the anterior longitudinal ligament in front of the vertebral body.
The area of infection gradually enlarges and spreads to involve two or more adjacent vertebrae by extension beneath the anterior longitudinal ligament or directly across the intervertebral disc.
Occasionally there may be multiple foci of involvement separated by normal vertebrae termed as skip lesions, or the infection may be disseminated to distant vertebrae via the paravertebral abscess.
The vertebral bodies loose their mechanical strength as a result of progressive destruction under the force of body weight and eventually collapse with the intervertebral joints and the posterior neural arch intact; thus, an angular kyphotic deformity is produced, the severity of which depends upon the extent of destruction, the level of the lesion, and the number of vertebrae involved.
Kyphosis is most marked in thoraccic area because of the normal dorsal curvature. In the lumbar area it is less because of the normal lumbar lordosisbecasue of which the body weight is transmitted posteriorly and collapse is partial
The collapse is minimal in cervical spine because most of the body weight is borne through the articular processes.
Healing takes place by gradual fibrosis and calcification of the granulmatous tuberculous tissue. Eventually the fibrous tissue is ossified, with resulting bony ankylosis of the collapsed vertebrae.
Paravertebral abscess formation occurs in almost every case. With collapse of the vertebral body, tuberculous granulation tissue, caseous matter, and necrotic bone and bone marrow are extruded through the bony cortex and accumulate beneath the anterior longitudinal ligament.
These cold abscesses gravitate along the fascial planes andpresent externally at some distance from tee site of the original lesion.
- In the lumbar region the abscess gravitates along the psoas fascial sheath and usually points into the groin just below the inguinal ligament.
- In the thoracic region, the longitudinal ligaments limit the abscess, which is seen in the radiogram as a fusiform radiopaque shadow at or just below the level of the involved vertebra.
- Thoracic abscess may reach the anterior chest wall in the parasternal area by tracking via the intercostal vessels.
Compression of the cord by the abscess or by the caseating or granulating mass, or by the posteriorly protruding border of the intervertebral disc or edge of bone can result into neural deficit. Other contributory factors may be thrombosis of the local vessels and edema of the cord.
Neural deficit can be paraparesis to begin with and eventually lead to paraplegia. It occurs most often in the mid-or upper-thoracic region, where the kyphosis is most acute, the spinal canal is narrow, and the spinal cord is relatively large.
Clinical Features
The onset of is usually insidious and of slow evolution. Initial symptoms are vague, consisting of generalized malaise, easy fatiguability, loss of appetite and weight, and loss of desire to play outdoors. There may be an afternoon or evening fever.
Backache is usually minimal and may be referred segmentally.
Muscle spasm makes the back rigid. Motion of the spine is limited in all direction.
When picking an object up from the floor, the patient flexes his hips and knees, keeping the spine in extension.
Spasm of the paravertebral muscles in the lumbar region is also elicited by passive hyperextension of the hips with the patient in prone position-this also puts stretch on the iliopsoas muscle, which is in spasm and contracture owing to psoas abscess.
A kyphus in the thoracic region may be the first noticeable sign. As the kyphosis increases, the ribs will crowd together and a barrel chest deformity will develop.
When the lesion is situated in the cervical or lumbar spine, a flattening of the normal lordosis is the initial finding.
On gentle percussion or pressure over the spinous process of the affected vertebrae, tenderness is often present. The abscesses may be palpated as fluctuant swellings in the groin, iliac fossa, retropharynx, or on the side of the neck, depending upon the level of the lesion.
The gait of the person with Pott’s disease is peculiar, reflecting the protective rigidity of the spine. His steps are short, as he is trying to avoid any jarring of his back. In tuberculosis of the cervical spine, he holds his neck is extension and supports his head with one hand under the chin and the other over the occiput.
If paraplegia develops, there will be spasticity of the lower limbs with hyperactive deep tendon reflexes, a spastic gait, a varying degree of motor weakness, and disturbances of bladder and anorectal function.
Radiographic Features
Findings are suggestive, but not pathognomonic. In addition to the routine anteroposterior and lateral views of the spine, linear tomograms, CAT scan, and nuclear magnetic resonance imaging are used to delineate bone and spinal cord pathology in detail. Chest radiograms and an intravenous pyelogram are taken to rule out outer foci of systemic disease in case of a suspected person.
The vertebral body depicts the initial changes; it becomes rarefied with loss and haziness of its bone trabecular pattern. Soon the vertebral body expands and its borders are indistinct. With progressive destruction of bone the vertebral body collapses. The intervertebral disc space first narrows and later is obliterated. Paraspinal abscesses may be seen quite early, presenting as fusiform or rounded shadows of water density.
In the differential diagnosis one should consider
- Suppurative spondylitis
- Leukemia
- Hodgkin’s disease
- Eosinophilic granuloma
- Aneurismal bone cyst
- Ewing’s sarcoma.
All these conditions may causes destruction and collapse of the vertebral body, narrowing and obliteration of intervertebral disc spaces, and paraspinal soft-tissue swelling, a picture also seen in tuberculosis.
Treatment
As soon as the diagnosis of tuberculous spondylitis is suspected, the patient is placed on bed rest and chemotherapy is initiated immediately. Patient is observed for response of the disease. A number of patients recover on chemotherapy.
Some of the patient may require surgical debridement or decompression of the cord
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Dear Doctor,
I did discuss this with my consultant last Wednesday. They took x-rays of my spine and from that they could not infer any problems. They have booked me to have an MRI.
I have also noticed that this pain and stifness is the worst in the morning. I also tend to belch a lot during mornings and after having my breakfast, this pain seems to subside quite a lot, although it does not go away completely.
I mentioned this to my doctor and his view his that this could be a side effect of the medication that I am taking. Is belching due to gas a common side effect of TB medication?
Regards,
KC
Dr Arun Pal Singh Reply:
August 5th, 2011 at 7:14 pm
@K Chakrabarty,
Gastritis is a common effect of these drugs. What does MRI say?
Hi Dr Singh,
I was diagnosed with bone TB on the T10/T11 region in December 2010 (although I have had symptoms of back pain 6 months prior to diagnosis). All blood tests, lung x rays, and biopsies came back with negative results. The diagnosis was made from my MRI scans. I was initially 5 different medicines – Myambutol, Pyrazinamide, Rifadin, Pyrdoxine hydrochloride, and Isoniazid. After 6 months I was taken off Myambutol & Pyrazinamide but on the other three.
In terms of symptoms, I do not have fever or any other symptoms related to the usual TB. But my back feels very tender. Any sudden movements cause immense pain. I can walk at a regular pace, but activities such as getting into a car or bending down has to be done extremely slowly – I have to hold my breath to withstand the pain. Every time I cough or sneeze causes immense pain. FYI I am in my mid 50′s.
I’ve had three MRI scans – one in December, April & another on 12th July this month. As per the scan com pared with my MRI on April, “there is increased signal within the T10-T11 disc, irregularity of the adjacent end plates, and high STIR signal in the adjacent vertebral bodies with associated enhancement within the disc and the verterbral bodies”. The findings from the latest report suggest that there has been “expected interval evolution. The signal within the disc and associated enhancement has decreased. There is less parvertebral enhacement. There is minimally increased collapse of the adjacent end plates”.
Compared to 6 months ago, I possibly feel an improvement of maybe 5 to 10% – but nothing more. How long can bone TB take to start showing significant improvement after treatment has been started? Obviously it will be different on a case to case basis. My work is very physical in nature and often requires weights to be lifted. I am currently on extended sick leave – but my concern is will I be able rejoin at some point in the future? Do people make a full recovery from this disease?
Many thanks for your time and help. The work you do on the Internet really helps people such as when going through such difficult times.
Kind regards,
Deb
Dr Arun Pal Singh Reply:
August 5th, 2011 at 7:22 pm
@DEB SARKAR,
There are two things that one needs to understand. One is the infection of the tuberculous bacteria. Another are changes caused by the infection in the body tissues.
The pain due to later takes a very long time. Your reports show improvement in parameters suggesting infection but your symptoms have not imporoved that much.
Patients do get well. It might take some time to perform physical activity.
my wife has been diagnosed with tb of the spine 2 months ago. she had an operation to take the abcess out on her spine. she was discharged after a month of staying in the hospital. she is on medications of fixcom 4. my question is why she still experiencing a severe pain on her legs? tingling feeling sometimes? she is so restless and worried? even shes taking a mefenamic acid and still in severe pain. is this normal for a people who just had an operation? please help us? ty
Dr Arun Pal Singh Reply:
August 13th, 2011 at 11:37 am
@aj tato,
Pain in the leg indicates compression on the nerve root. [You did not mention the level of the spine involved but I assume it is in either thoracic or lumbar level.]
When did the pain start in legs. Is it progressive in nature. What does your treating doctor say?
HAI IHAVE TB ON LUMBAR SPINE I NTOOK TREAT MENT 2 YEARS CONTIOUSNLY LIKE RIM PHAPHYSIN AND ALL
. IT WAS 3 YEARS BACK NOW IAM NOT CHECKING ANY THING IS THERE IS ANY CHANCE TO COME AGAIN THIS . AND WHAT CHECK UP I CAN DO
Dr Arun Pal Singh Reply:
August 13th, 2011 at 11:47 am
@SUMI,
Please avoid all CAPITALS
Do you have any symptom right now or you are just being apprehensive.
Hello Doctor,
My fathet 49 and he is dignosed with spinal tb in t2 and t3 docs said they are 96% sure its tb now he is having tb madicines from past 15 days he was having numbness in lower body but now he is felling better.but as he is on bed rest n xrays have shown tromatic injuries on ribs aswell he is suffering from severe pain in ribs when breating.i just wana know is it because of injuries or spinal tb?for more then 2 years doctors have been treating hin for spondilitos n now comes the tb.Sir i request please reply in detai.I also wana ask my father is having compression on spinal cord aswell is it possible that the pressure release with medication.Thanks alot sir
Dr Arun Pal Singh Reply:
August 13th, 2011 at 11:54 am
@Ameer,
You need to provide more details please. Did he suffer any injury in the ribs.
Dear Sir ,
My mother is 54 years suffering from tb spondylodiscitis,small epidural collection is noted extending from L5-S2 .She was on treatment of AKT4 for 2 mths and now on AKT3 ,Dr has advised her for excercises which she does regularly I have queries:
1. she has pain in right leg mostly somtimes she is relaxed but somtimes has very much pain in thighs and ankles is it normal thing in this treatment
2. will she able to perform her routine duties like before
3. she is unable to bend
4.can she go in squatting position for urination
Dr Arun Pal Singh Reply:
August 13th, 2011 at 1:53 pm
@Riya,
1. Pain can be present. Should go with time
2. Cannot be answered by me. You need to ask your doctor.
3. OK! What about that?
4. It is advisable to sit on English commode. If your household does not have one, chairs are available. Squatting should be avoided for a while.
I was diagnosed with idiopathic lumbar scoliosis with right sided convexity a year back. MRI and X ray did not show any sign of TB or nerve compression at that time. In Feb-Mar 2011 I developed lower back pain and visited orthopedic clinic. It was diagnosed as acute muscle spasm and no further investigations were done. Physiotherapy was recommended for same. In June 2011 I had dry cough, low rise fever, weight loss and weakness. ESR was 100 plus. On consulting physician, possible diagnosis of TB was made. However, on normal chest x-ray and negative serum TB-PCR (from Blood sample) but positive mountoux test, I was given levofloxacin for symptoms. The symptoms relived well with near normal ESR with 25 days of levofloxacin treatment. Physician also kept to treatment with AKT open if the symptoms reappear. No spinal investigations were done by any of the doctors.
I visited different orthopedic surgeon for persistent back pain. X-ray was performed and showed possible tubercular lesion near D 10 to 12 with scoliosis to right side. With considering the symptoms of TB in past with High ESR and current X ray findings, I would be diagnosed as a case of spinal TB.
What could be the etiology of TB spine? Can underlying scoliosis play a role?
I do not have any complain except back pain. Do I require having bed rest?
Would AKT treatment without bed rest help?
When should I start physiotherapy? Do I need to stop exercises for scoliosis?
What should be the best treatment plan?
Dr Arun Pal Singh Reply:
August 13th, 2011 at 2:00 pm
@Jatin,
Tuberculosis of the spine is caused by an infective agent of name Mycobacterium tuberculosis. Scoliosis is a spinal deformity and has no role in causation of the disease.
Bed rest would depend upon the neurological involvement. Ask your doctor about the rest requirments.
For other things, let your treating doctor decide the case
Hello Doc,
I was suffering from low grade fever since january, all TB test were negative at that time… Since march i was having lower back pain and in may i was diagnosed(MRI) with potts spine involving T10 T11 T12 – L3 vertebral body along with soft tissue, collection in paravertebral region in right side also involving right psoas muscle, bone deformity along with collection extending into epidural space with dural compression… involvement of posterior elements and right sacro iliac joint is also seen.. doctor has not advised me any kind of surgery till now.. i’m on AKT-4 since 1 month.. Also i feel dizzi after taking anti tuberculous drugs… I also got fever 2 days back…
Thanks…
Dr Arun Pal Singh Reply:
August 13th, 2011 at 1:55 pm
@Rahul Arya,
What do you wish to know?
hello doctor,
i had lung infection (tb) in year 2003 and got treated for six months and got cured, later in year 2007 i was diagonised with bone tb in spine and coller bone and got treated with medicines and injections and got cured. again now m having pain in the same area. when we took x ray its normal and in esr its 18. esr and x ray report is normal but dont know what should i do next. m 24 yr old and i have year old kid. kindly help
Dr Arun Pal Singh Reply:
August 13th, 2011 at 2:09 pm
@suleka,
Most probably you wish to ask if you have got the infection again.
For that you need to visit to a doctor who can examine you.
Please a doctor.
HELLO DOCTOR,
MY MOTHER IS SUFFRING FOR BONE TB IN SPINE. 1YEAR 8MONTHS.SHE IS 52.
SHE IS USING TB MEDICEN. BUT THERE IS NO RESULT. NOW DOCTER SAYS FOR OPERATION,BECAUSE THE MEDICEN IS NOT WORKING. BUT SPINE OPERATION IS DANGEROUS.
I WANT TO KNOW WHY THE MEDICEN IS NOT WORKING.
Dr Arun Pal Singh Reply:
August 13th, 2011 at 2:25 pm
@usha,
Please avoid ALL CAPITALS.
There cannot be a specific answer for this question. There are several reasons which may include resistance, high bacterial load and many others but it is very difficult to pinpoint cause in a particular person.
To update those who are interested in my case, after I stopped the levaquin the pain became so severe that I can barely breathe, it was a horrific experience with not many people can help and many Drs are scared to prescribe antibiotics without cultures. I was in a really bad situation. One Emergency room Dr prescribed Clindamycin and I saw imeediate relief, not being able to get more then a 7 day supply and not wanting to search for another infectious disease, I flew over seas and continued the oral clindamycin 450X 3 a day. I plan on starting IV of 600 x 3 a day in two days. Whatever I have is very sensitive to clindamycin. Out of fear of creating resistance and not wanting to stop the clinda I flew overseas where I can get it without a script. I hope it completely erradicates this bacteria as I dont know what to try next. I plan on staying on IV for 6 weeks then continue for another 6 weeks on oral. I want to make sure this thing is out of my system as its very aggressive and very destructive. It destroyed my soft tissue ( I felt this clearly) Then it started attacking the joints and bones which I felt both. I never ever want to feel this pain again. My concern now is “C diff” which clinda is famous for, but willing to take the chance. I dont want to relapse Dr. Singh.
Dr Arun Pal Singh Reply:
September 1st, 2011 at 1:10 am
@Bass,
Clindamycin is effective in range of bacteriae. Has therapy worked [Though blind] ?
How are things?
Dear Sir,
Thank you very much for your advise.
Sir, we have repeated MRI after 3 months of AKT treatment and compared with earlier before AKT ,there is no change at all .My mother has started walking but she has no relief in the pain and complains about the heaviness, she has completed 3 months taking the treatment ,please tell me
1)how much more time will she take to recover fully
2)can she bend
3)what precautions she must take
Thanking you
With regards
Riya
Dr Arun Pal Singh Reply:
August 30th, 2011 at 10:19 pm
@Riya,
Please ask your treating doctor about your doubts. He is in a better position to answer your questions.
I have been diagonised with Spinal Tuberculosis affecting T3 and T4 In Australia on 13th April 2011.I started with Ethambutol,Pyrazinamide,Isoniazid and Rifampicin.After two months I stopped Ethambutol and Pyrazinamide on doctors advise.Now I am currently using Isoniazid and Rifampicin.I returned back to India and still feeling pain and itchy feeling in the back.I have gone through an MRI on 21/07/2011 on and the MRI states that”Wedge collapse of D4 vertebral body with heterogenous altered signal intensity involving D3 and D4 vertebral bodies with minimal posterior subluxation of D3 vertebral body with a mild prevertebral soft tissue component extending from the superior border of D2 to Inferior border of D4 vertebral body”.
-Is it alright to start using Indian medicines as i am running out of the medicines i brought my Australia as i am extending my stay in India Due to pain?
-How long does it take for me to get normal(i.e when does my back pain reduce)?
Thank u for providing the information.
Dr Arun Pal Singh Reply:
September 5th, 2011 at 1:56 pm
@Chanti,
There should be no difference in the two medicine when you match the dosage.
It varies from person to person.
Some people get better within 3-6 months, other may take longer.
Iam 34yrs old.diagnosed of tb spine of thoracic and lumber region.iam having paraplegia.but the tb has been eradicated.the paraplagia has not stopped.what do i do.
Dr Arun Pal Singh Reply:
September 8th, 2011 at 7:15 am
@Nora,
If there is a compression on spinal cord, it needs to be removed. If compression has been relieved one can only wait for power to return.
What a disaster Im dealing with, the Clyndamycin was probably the fastest and best drug “I have tried. I was flexing a lot more in two days which normal antibiotics I tried in the past would take 15 days. This was a very potent drug that had good penetration. For some reason it was short lived. I blame this on an article I read that Oral Antibiotics should never be prescribed to bone infections other then TB. With the acception of Fluoroquinilones due to their great bioavailaibility. I lost the effecxtiveness of Clyndamic but it has opened my eyes to bring up something to a few physicians overseas. To go back to my original story, I had severe kidney pain for 3 months or so with WBC, RBC, nitrites in urine. Negative cultures were reported in more then 10 samples. Keflex resolved the pain in 5 days or less and the pain was gone in the kidneys and no more WBC or RBC. My Infectious disease started Rocephin based on that its similar to Keflex. However after deep research and gathering all my information together. I have learned that Keflex which is a first generation Celaphasporin is active against Anaerobic bacteria, while Rocephin a 3rd gen Celaphasporin isnt as good as the 1st Gen. this also explains the negative urine cultures for months, as Anearobes require different methods to cultures then Areobic bacteria. Clyndamycin is also one of the best drugs for Anaerobes which explains the fast response and flexibility in a matter of 2 days. Very upset the Clinda was short lived. With that information and Clindamycin loosing effectiveness I started IV Flagyl, sure enough it reliefed my pain. Different then Clindamycin, Flagyl only treats Anaeribes, and confirms once again this is an anaerobic bacteria. The sad news is, there arent many choices to treat Anaerobic osteomylitis and Flagyl has very poor bone penetration, unlike Clindamycin. Iam not sure what will happen, I doubt flagyl will cure me but its buying me time until I have a new plan. I would like to go back to the states once again for proper treatmtent but its a disaster there, so I will try not to fly until I have something setup from here. The only next drug which isnt available in the country im in is Meropenem, it has good anaerobic coverage as well as bone penetration. I was told by one physician to try thaimphenicol but hesitant after reading serious side effects to its sister drug. At this point I think my life is in danger I have tried many oral antibitoics due to the poor healthcare system in the USA and as a result I have built resistance to many drugs. Iam not sure what I will do if Flagyl fails or doesnt finish the job. I have setup a will and planned for the worse as its looking dimmer and dimmer. I wish I had TB and not this infection as its more easily treatable.. Always up for advise. Thanks for this great place to share my spinal infection with.
Dr Arun Pal Singh Reply:
September 28th, 2011 at 12:30 am
@Bass,
I wish you all the luck. It has been so long. May you get well soon.
One more thing to add, is that every morning when I wake up the area of pain has a lot of popping and once again in mid day. I have just read an article about how Anaerobes build gas inside the bones as they ferment. This once again my confirm that I have an anaerobic Bacteria. What are my other options here Doc? Very upset the Clindamycin stopped working, had I taken it Iv from the begning at the hospital at the right doses this would probably never have happened. Thanks to Dr. Law at St. Barnabus Medical center in West Orange New Jersey.
Dr Arun Pal Singh Reply:
September 28th, 2011 at 12:33 am
@Bass,
At a distance I am of very little help to you. Things I utter may as well confuse the situation more.
But please do keep updating. I have been following your progress closely.
Take care.
need to knw if pyrazinamind stoped due to sideefect does it affect on relapse.i will give u detailed history i havebeen diagnosed as thorasic spine kochs after treatment of one month i had side effect of pyrazinamind arthalgia so my doctor stoped it and give some anather drug…am continuing this since month my symptons disappered ..one of my other doc told me i may have relapse with this….does it affect in relapse…will i have relapse am confused.plz help.
Dr Arun Pal Singh Reply:
September 28th, 2011 at 6:55 am
@keshao,
If side effects are strong, the medicine needs to be removed from regimen and replaced by another one.
Relapse is not determined by the type of drug you take.
Pyrazinamide is needed in first two months of antitubercular therapy.
But if the patient do not tolerate it is very right to change it to some better tolerated med.
I would like to know how much time it would generally take for disappearance of the cold abscess of 5*6 cm size? Will only medicines do or need surgery (no neurological symptoms)?? Is it possible to aspirate the abscess percutaneously?
Dr Arun Pal Singh Reply:
September 14th, 2011 at 12:27 pm
@jatin,
Cold abcess reduces in size as the disease is taken care of and may take few months to go.
It is aspirated only if it is very big and not responding to medications.
Dear doctor sir, my father has been suffring from spine Tuber closis for five years . I was make the treament but he is not complited the course of drug, I was make the again treatment , docotor says that complited the couse of two years. I had starting the dose of durg about sixth month . But he complitly on bed and no sans availble waist in down side, please doctor sir, tell me about any remedy in this disease
Dr Arun Pal Singh Reply:
September 28th, 2011 at 12:43 pm
@jitendra kumar,
Spine tuberculosis is a complex thing and you need of provide all the relevant details if you expect a helping answer.
Please provide as much info as you can and if required I would ask the things.
Dear Doctor,
I have been diagnosed with TB of the spine 3 yrs back and I have used AKT medication for nearly 2 years. The pain completly gone off that time but now again I am getting some pain in my back and legs. What should i do now..?
Dr Arun Pal Singh Reply:
September 28th, 2011 at 12:45 pm
@Gandhi Yandapalli,
As you have had an episode of tuberculosis, you need to rule out if it is a relapse. If it is not then other causes might be addressed.
You would need to see your physician.
I HAVE A SPINAL TB FOR 5 MONTH.MY TREATMENT IS GOING ON SGPGI LUCKNOW IN HAND OF PROFS. U.K MISHRA.I HAVE TAKEN A MEDICINE P-ZIDE,SOLONEX,COMBUTOL.BENADON,LEOFEN,ETHOMID,ECOSPIRINE,WESYLON,R-CIN,MAXAGALLIN. IS THIS RIGHT OR WRONG.PLZZ TELL ME..
Dr Arun Pal Singh Reply:
September 28th, 2011 at 12:50 pm
@ANKIT GUPTA,
I would not comment on right and wrong of the treatment as I am not as informed about you as your treating doctor.
If you are looking for a second opinion, you can see another physician in person.
i have been having this neck pain since 2008,i always feel a grip on my neck muscle and its a sharp pain on the left side of my neck,its so painful that i wouldn’t be able to turn my neck till the pain last but usually the pain does’nt last for two day,i went to my doctor and i was given injection and drugs,the pain relieved me but still comes once in a while especially at night when I’m sleeping but whenever i rub it with neurogesic ointment i will be relieved,but last week the pain started again and it was so serious that i have to see an orthopedic doctor,i did several test including tuberculosis test but all was negative,i did X-ray and the doctor concluded and diagnose me of tuberculosis of the spine.
i can walk properly,bend and i don’t feel any pain in my back,i don’t cough, i have appetite and i don’t feel any pain in my bone except in the left side neck muscle.its always painful when i turn my neck upward or downward towards the left side.
please could it be tuberculosis of the spine and what do you suggest i do.
Dr Arun Pal Singh Reply:
September 28th, 2011 at 1:13 pm
@ wale,
If your doctor has diagnosed it as tuberculosis then If your doctor there would be some kind of suggestive evidence for making this diagnosis.
If you still feel otherwise, you can opt for a second opinion.
I’m 32 year old male suffering of tb of the spine
It started last year october with a back pain visited a gp gave meds for pain but as time went by
I began to feel my legs heavy and from my waist downwards it became numb
In the last 20 days I can’t even bearly walk
I been for an mri and they said I have tb of the spine
My t9 vertebra has coLlasped thus damaging 4mmof my spine
I am in bed at all times but except for the toilet and shower
They started me on tb tablets RIFAFOUR®e-275 TABLETS
But wat will happen to me will I improve or get worst or do I need an operation
And how soon
Please com back to me asap
0826270085(south africa)
Dr Arun Pal Singh Reply:
October 12th, 2011 at 10:46 am
@muhammed,
I have answered your query here
hello doctor
i had tb spinal in 2006 n then relapse in stomach in 2008 so after complete medication though TB is cured but my lower back problem still persisting, i am not able to live normal life,my age is 62yrs,though i have been doing regular excercises guided by my physiotherapist which has resulted in imporvement n now i can sit for abt 3hrs whereby 3yrs ago i cud sit only for 20 mts
my question is
will i ever be able to live normal life like i can do my yoga or cud go walk for longer distance bcz after abt 30mts walking my lower back starts paining n i need atleast 3hrs bed rest or hot water pack
please suggest what is the way out to live normal life
Dr Arun Pal Singh Reply:
October 14th, 2011 at 3:31 pm
@yp sharma,
What does your treating doctor say?
If you have your documents to look at please ask your query at Bone And Spine Forums and attach them as well
My mother age is 51. she is being suffering from back pain for the last 11 months. Recently last 7 days she went to a neuro medine doctor for this suffering. Doctor suggets for MRI of spine, ESR, CRP, Mountaux test. After report she had finding TB in spine at D-8 and D-9 along with spinal nerves compression. Doctors pescride AKT-4, Benadon 10mg, Pantoacid for the period of 9 months and told patients to take complete bed rest for a minimum 3 months. please suggests me that this type of tb is curable or not, what does complete bed rest means. we don’t want surgery becoz she is suffering from diabaties and also borderline kidney diseases. Please help. waiting for your reply.
Dr Arun Pal Singh Reply:
October 14th, 2011 at 3:26 pm
Priya,
Spinal TB is treatable. Surgery is indicated in some cases where needed. Complete bed rest means lying on the bed all the time and not sitting at all. TO avoid pressure sores patient is advised to turn sides every two hourly.
For further discussion, please post at Bone And Spine Forums
dear sir,
my name is ankit from shahjahanpur.i hav spine tb for 5 month but i have relieve at this time but in my waist is very weak when i stands. tell me about this and also tell me when i will walking smoothly..i am worry about this..
Dr Arun Pal Singh Reply:
October 14th, 2011 at 3:21 pm
Ankit,
Please post your details at Bone And Spine Forums and attach documents as well. Please post everything in detail and I would be able to answer you better.
I will give just a bit of history, As a young child I developed TB. I am 58 now, A number of years ago I had back surgery on the L3,L4 for two herniated discs. I am repeately becoming ill alot. Go to work for a bit offagain. At present I have developed pneumonia. My question is can latent tb come back with the onset of TB. And two, With my back history, Is is possible I may have TB of the bones. Or tb ingeneral .I have fibro . Out of 18 points I have 12. Degenerative disc disease. I was just wondering if these symptoms could be the return of TB. No sure .
Dr Arun Pal Singh Reply:
October 8th, 2011 at 7:51 am
@sandy,
It is difficult to tell this from a distance. It cannot be said for sure and the at the same time possibility cannot be ruled out.
Only way to find and confirm is to get exmamined by a qualified physician.
Sorry, on my earlier post. I meant to say can latent tb come back with the onset of pneumonia .
Dear Sir
My mother suffering from tb spondylodiscitis,small epidural collection is noted extending from L5-S2 .She was on treatment of AKT4 for 2 mths and now on AKT3 ,Dr has advised her for excercises which she does regularly She was fine but from few days she has pain in lower limbs.MRI was repeated after 6 mths there is no change plz answer my queries
1. how much maximum time does AKT3 takes to recover
2.will she need surgery how could be decided
3. will the abscess removed by medicines
4.how much time she vl take to come in her routine.
I will be very thankful to you Sir
Waiting for your reply
With Regards
Riya
Dr Arun Pal Singh Reply:
December 17th, 2011 at 7:11 am
@Riya,
1. AKT 4, AKT 3 and AKT 2 are used in sequence for Tuberculosis treatment. The condition is gauged from clinical improvement and not MRI.
2. Surgery is decide based on many factors like no response to treatment, worsening on treatment, reaching a plateau etc.
Most of the surgeries are performed on patients with neurological deficits.
3. If it is tubercular, yes!
4. It varies from patient to patient and level to level but mostly fall between 3-6 months.
Dear Dr. Singh,
My nephew had back pain for about 3 months on/off and MRI done showed findings suggestive of Kochs.
He is 24 yrs old. He was diagnosed with this in mid August.
He did not get biopsy but based on the MRI findings, it was diagnosed as Potts spine at L2verterbral bodyl and superior end plate of L3 also. He was started on Ofloxacin, INH, Rifampin, Ethambutol, Pyrazinamide, Pyridoxine and steroids also as he had mild soft tissue swelling and epidural enhancement. He was on steroids for aboiut 3 1/2 months as was tapered to 10 mg and stopped now. As long as he was on the steriods, he did not have any pain on a daily basis except for few days of pain here and there. Now after he stopped steroids, he is having pain in the back, stiffness like before the diagnosis, also has severe neck pain, stiffness, body aches. MRI done after 4 months shows no change in the findings.
Can we except to see bony improvement or soft tissue signal improvement in 4 months?
Doctor says, he has no motor deficits, no need to worry but consider getting biopsy.
I would like to know that if there is no worsening, is it a good sign that meds are working and so no worsening is seen.
Thank you so much,
Asha
Dr Arun Pal Singh Reply:
December 17th, 2011 at 6:52 am
@asha,
First sign that we look for is clinical improvement and not on MRI.
If you think that he has shown no improvement in this period, diagnosis should be established.
Biopsy may not be bad idea if there is absolutely no improvement.
Till now steroid have masked the symptoms and signs.
Discuss the things with your doctor and if that does not help, getting another opinion in person from another specialist is an option.
Hi sir,i am ankit gupta and 24 year old.my legs is strong but waist is very weak for two month due to this i cant move but stands properly.for strong waist what will be do.any massage oil or medicine or therepy.plz. suggest me.
Dr Arun Pal Singh Reply:
January 7th, 2012 at 3:17 pm
@Ankit gupta,
Hi, Did you see a doctor?
I got my mountex and quantiferom gold +ve..Chest Xray and ESR serology all clear. no fever, but sometimes little cold and cough but no blood. i got weight gain these days.
But i am a young hypertensive since two years(Amlodipine 5 and metropronol 50 daily) . I am having numvbess in my left leg, feeling difference in my lower left leg while walking . i do have pain inmy neck. smtime sudden spinal pain and have to take the injection(Dexona?)..
Is this signyfy a bone/nerve TV..
Please suggest i am about to leave india. got 457 visa 4 austraila.
sushil
Dr Arun Pal Singh Reply:
January 7th, 2012 at 4:18 pm
@sushil,
Did you see a doctor? I think you need ot see one.