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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About Dr Arun Pal Singh
I think that sometimes we have to make the diagnosis of tbc Potts abcess based on clinical and radiological findings without tissue or culture confirmation! please correct me if you think otherwise
Dr Arun Pal Singh Reply:
May 27th, 2009 at 4:18 am
Yes Rami! you are absolutely right. Clinicoradiological diagnosis is quite reliable method in endemic areas like ours
v gud description.excellent.
greetings doctor!
my friend was diagnosed having a tb on the spine and the MRI says that small central disc protrusion with mild Disc dessication change at L5 -S1..no compression deformities.. …she suffered of partial paralysis on lower extremities thus she can’t stand., numbness on the palm… and a severe back pain..
what is usual treatment on case like this?. what is the prognosis after chemotheraphy?
Dr Arun Pal Singh Reply:
July 17th, 2009 at 1:46 am
@analyndmdphil,
The ususal tretament in tuberculosis of spine that mostly people follow in India is that of initial rest and chemotherapy. The patient is put on absolute bed rest and medication is started.
The patient is observed for improvement and if it is not there. a decision for surgical decompression is made.
The prognosis in incomplete compressions (As probably in this case as you said the paralysisi is partial) is usually good if the patient responds well to the treatment.
i am suffering with tb in my spine, in LT1 and LT2, the doctors say that the disc between the two vertebras is reduced, have started on the tb antibodies, but if not improved they suggest surgery. in which they will place steel screws inside the bone after cleaning the tuber, oral treatment in suggested for a yr.
i need your opinion regarding the case. what kind of surgery is this and how much time is possiblely taken to recover on oral treatment.also the seriousness of the case.
thanks
Dr Arun Pal Singh Reply:
September 15th, 2009 at 2:50 pm
@bhawna,
TB spine needs to be operated if there is a neural deficit which is not responding to medications or is worsening in spite of medications.
Neural deficit means weakness in the limbs and in late cases complete loss of motor power and loss of bladder bowel control.
Most of the patients respond to medications though.
You have not mentioned a clear level in your comment. Is it L1 and L2 or T1 and T2.
Duration of the oral treatment is independent of whether you undergo surgery or not.
my brother is suffering from tuberculosis in l2.the doctors advised him complete bed rest for initial 6 weeks and said can work after another MRI report.actually some of the doctors also suggested for a surgery.but we dont want a surgery so we are giving him medicines like forecox,mysopaz,levoday etc.i want to know that how much time it will take 2 recover if we go through the medicine process.plz reply as soon as possible
Dr Arun Pal Singh Reply:
November 3rd, 2009 at 2:12 am
@deepali,
Medicines and rest are first line of treatment in tuberculosis of spine. Surgery is indicated if patient is not responding to conservative treatment.
Its recovery is a long process and up to 3 months bed rest is advised if all goes well. FOllowing that movements are allowed with brace.
The medicines continue at least for a year in our institution and sometimes prolonged to 1.5 years.
The period of treatment would be same in case of surgery too.
thanx alot doctor…
i would also like to know the cause of this disease?
as doctors told us that it occurs in a very few cases..
Dr Arun Pal Singh Reply:
November 5th, 2009 at 3:09 pm
@deepali,
It is not an uncommon disease as such. The lumbar area is affected in few patients though.
It is infection by Mycobacterium tuberculosis.
doctor singh, i have a history of tuberculosis month of march 2009 after 3-4 months taking a medicine month of july i decide to work again in my company and the result of xray are fine my lungs are clear, the problem this month of december 2009 i experiene back pain chest pain my spinal chord aching my bones are in trouble i cant move and walk properly what should i do? can you give me some advice what kind of medicines should i take? ouch!
Dr Arun Pal Singh Reply:
December 7th, 2009 at 4:30 am
@lai_050511@yahoo.com,
I think you need to visit your doctor in view of fresh developments.
Sir
Please see IJT OCT 2008 fob more information.
Dr Arun Pal Singh Reply:
February 18th, 2010 at 2:45 pm
@dr.k.venugopal,
Saw your article. Good work.
hi doctor,
i am an indian stzying iin uk form 3 years.
i am suffering frm back pain and neck pain from 8 mnths. but heere they dnt recignised that is due to spine tb.
when i went t my doctor 20 days back they did some x-rays of my neck nd back and admitteeed me in hosipatal saying i have spinetb nd shuld be on bed.
i am there frm 20 days nd they gave me brace.
but here nhs is nt that caring i fell to come back to india so i can get good treatment.
but my question is am i allowed to travel now?
nd i have pins nad needles in my both palms and my are ok
now i am wearing brace all the time except on time of sleep.
please do suggest me
Dr Arun Pal Singh Reply:
March 17th, 2010 at 8:45 pm
@rani,
It would depend upon severity of your disease and if you are allowed to sit.
I think talking to your doctor would help on these issues.
hi docter . my spinal tuberculosis ( L2 – L3 region) was detected on 25 august 2009 after my MRI report. At that time my ESR was 25 (10-15 is the normal range). Docters advised me complete bed rest for 3 months and suggested me a boston brace . they advised me to use myrin-P (5 tablets) alongwith vita 6 (1 tablet) every morning.After 3 months , my ESR level rose to 35 and i got depressed .i was unable to walk properly and the pain was at its peak . At that time i was even unable to go to the bathroom.few of my X -Rays showed that one of my disc was compressed/collapsed to such an extent that it almost disappeared but i continued my medicine despite of the fact that some of the docters were advising me surgery(to replace that damaged disc with an artificial one made up of tungsten) .now after 7 months my ESR level has declined to 8 and my infection has gone. i am also going to my office.But the pain is still there.i can’t walk without the stick properly. what should i do? there is still pain in my backbone in the lower side. and please tell me about the medicine.should i continue my medicine/ if yes then for how long ?
Dr Arun Pal Singh Reply:
April 13th, 2010 at 7:04 am
@ishmeetking,
Anti tubercular medicines at our centers are usually given for a year with or without surgery.
You have shown improvement and your infection has responded.
But it may take some more time for back to become normal.
Normally we do not offer disc replacements in tubercular spines as the results are good without it too.
sorry the artificial disc was of titanium……..waiting for your reply
Thanks docter.should i take some calcium suppliments or any sort of injections for my bone or it will recover itself? and at this stage is rest important for me or not ?as i return home late at night ….
Dr Arun Pal Singh Reply:
April 18th, 2010 at 1:36 pm
@ishmeetking,
Usually it does on its own. Calcium supplements are usually not prescribed if you have a good balanced diet.
I have been diagnosed with spine TB on D9 after an MRI scan was conducted. A biopsy was conducted and the results said that ” probable case of Kochs”. I then took the MRI and biopsy report to a spine specialist who has asked me to take AKT-4,Benadon for 2months. He told me that after 2months another MRI will be required to find out whether it is working or not. It has been more than a month since i have started and the pain has subsided . I have resumed going to the office. Just wanted to know if i am going in the right direction or not?
Dr Arun Pal Singh Reply:
April 30th, 2010 at 10:26 am
@jacob,
You are getting better. It is a good sign. Get an MRI and you would have an objective evidence also.
I was diagnosed with TB of the spine. Doc says I am really lucky it was contained in only one vertebrae L4/L5. Although the bone has been almost entirely eaten up according to MRI, is this damage irreversible?
Dr Arun Pal Singh Reply:
May 21st, 2010 at 8:05 am
@Gracie,
The destruction usually doe not reverse. That means if a vertebra is collapsed, its height would not be restored back even after the disease is controlled.
That is if the structural damage has occurred.
Hello Doctor
My friend was diagnosed with bone TB in spine in Jan 2008. She was given TB pills and she recovered. When she was ill she could not move also she could not recognise people around her and she lost control over bowel and bladder. She used to make stories which were not related to anyone. She took pills continuously for one year and she recovered well. even she started work and also she could remove her brace and work without pain as well. Again in February she took some tablets to dry up the fluid content in her spine as she told me since that time again she has started to have some pain and now she is so weak that she can’t even get up from the bed she needs support to do her personal work and now she has lost her bowel and bladder incontinence. Sometimes she cries at the bed when she bends her legs or straightens them. Is her TB is coming back? please tell me about her condition
Dr Arun Pal Singh Reply:
May 26th, 2010 at 10:55 pm
@Krishna,
Only way to know if the disease is there is by visiting a physician. Mechanical back [pains following tuberculosis are common but the disease itself should be ruled out.
hello Dr. Singh,
my friend accidentally slipped and hit his right buttock/hip against the ground. (last march)
and he was diagnosed of TB of hip right with hip subluxation. what does this mean & is it associated with pott’s disease, how?
what are the exercise that you can recommend for him?
by the way he is 9 years old and has a double hip spica cast.
hope you can tell me…. thank you
Dr Arun Pal Singh Reply:
June 16th, 2010 at 12:21 pm
@bailore,
This means he has TB of the hip which is causing his joint to move out of the socket.
Antitubercular medicine and immobilization as done seems to be reasonable line of treatment.
Exercises would come later.
hello docter singh,
I had told you about my condition earlier … just wanted to say that i have recovered a lot. tx for your advice . . now i was just wondering that will my collapsed disc recover ? will the whole structure would become as it was used to be? hope you understand what i am saying
Dr Arun Pal Singh Reply:
June 30th, 2010 at 7:19 am
@ishmeetking,
No! It usually does not comes back to previous shape but if the deformity is not significant, it should not cause much problems.
hello doc
I wrote a comment but now it is removed.. i asked that whether my disc would recover from the collapsed state ? will the disc recover to its original size and position?? please reply?
Dr Arun Pal Singh Reply:
July 4th, 2010 at 6:54 am
@ishmeetking,
I did answer that. Sometimes it gets delayed due to engagements.
I hope your query was answered well.
Hello Doctor,
My mother had ongoing fever and severe back pain in February. We went to doctor who told that she is likely to have Cochs after MRI scanning, and partial collapse of D10. She was operated and spinal decompression was done. After that, she has been on AKT4 medication since March 31. There is no longer fever. But she is bedridden and cannot getup, even physiotherapy is done every alternate day. She has become very weak. Can you pl clarify:
1. How long should we continue with AKT4 before switching to AKT3 and how long should the TB medication continue?
2. What is the best method to make her mobile?
She is also suffering from Parkinson disease for few years and taking syndopa, pacitane medicines.
Dr Arun Pal Singh Reply:
July 4th, 2010 at 6:58 am
@sundaram,
1. 2-3 months. In some cases it may be prolonged.
2. Please ask your doctor about this question as I cannot answer this based on the information you have provided.
Hello Doctor, my brother has been diagnosed with D5,d11 d12 kochs.He has been prescribed t.akt4 and T.pyridoxine 40 mg,t.flexilor p 8mg,t.lysoflam mr .he has been taking the medicines since 28.april.2010.The swelling has increased and there seems 2 b no improvement.pls.advise.
Thanks and regards
Bhaskar
Dr Arun Pal Singh Reply:
July 4th, 2010 at 7:03 am
@Bhaskar,
Talk to your doctor and he would be in better position to explain everything to you.
my dad started having pain excruciating pain in his neck and was hospitalised 4 it.while on hospital bed he lost movement of d limbs. He has now been diagnose wit tb of d spine after an MRI investigation and has bn placed on anti tb medication.pls do u tik he will b able to use his limbs again.
Dr Arun Pal Singh Reply:
July 16th, 2010 at 8:28 am
@mary,
Tuberculosis is a treatable disease. Paralysis of the limbs is as result of compression caused by many of the factors as a result of the tubercular process.
The prognosis depends on many factors too. Therefore I advise you to talk to your treating doctor.
Most of people with right treatment do recover.
Dear Doctor,
My 78 year old grandmother is suspected of TB of the Spine. She had been complaining of chest pain and this was misdiagnosed earlier as a muscle pull. Much later, this month, after several trips to multiple doctors, we were told she had suffered from a fractured vertebra that was not showing up except in the MRIs. It has revealed that D2 is compressed and over the past month, she has lost strength in her legs and they’ve been graded at grade 2 rather than the grade 4 just 2 weeks before that. Surgery seems to be likely, but from being very healthy and up and about in March, she has now become bed-ridden. Is surgery the only option and should they be thinking of replacing D2 with a titanium ring at this point? What options should be discuss with the surgeon and what other precautionary steps should we take prior to her surgery? (They might just schedule it in 4-5 days since she is already hospitalized.)
Many thanks for your column and any non-binding advice that you may be able to offer. Guidance of this sort is extremely helpful since we have had nearly 5 months of misdiagnoses by multiple specialists.
Dr Arun Pal Singh Reply:
July 28th, 2010 at 4:33 pm
@Raghu,
There has been extreme delay in answering and I am very sorry. Many of your questions might have become irrelevant now.
Has she undergone surgery?
hi doctor
my mom slipped on 16 may 2010 and got fracture in l1and d12 in spinal cord
i want to knw how much time would it take for complete recovery
she is taking medicines and is on complete bed rest for 2 months
also i want to knw can this fracture be recovered completely
Dr Arun Pal Singh Reply:
July 28th, 2010 at 4:47 pm
@kanishk,
At least 3 months rest is recommended before making patient upright. Further progress may take further few weeks depending upon patient strength and participation in rehabilitation.
Dear/Doctor,
I was suffering from lower back pain from 1995 and it was increasing year by year up wards in spine. Dignosed by MRI as Spine TB in D11-12, L4-5 & Left Hip in Sep.2009 and since then, I took AKT4 (1month),AKT3(8 month) and R cinex +Banedon from Jun.2010 (total treatment 11 months)But no effect so far. Will it take time to effect due to old case ? Should i continu full course? My doctor suggested for biopsy test but Radiologist said it is only tb nothing else, not interested for biopsy . Please advise. Thanks.
Dr Arun Pal Singh Reply:
July 28th, 2010 at 4:53 pm
@s.p.,
There could be two factors for not getting relief.
Wrong diagnosis or no response to the treatment.
The second may be caused by drug resistance. Get yourself evaluated and if diagnosis was on clinical basis only then I would suggest you to undergo a biopsy.
HELLO DOCTOR.
I AM A DOCTOR BY PROFESSION.MY RELATIVE HAS BEEN DIAGNOSED WITH TB OF L5 S1.
HE HAD FEVER FOR 4MONTHS LOSS OF WEIGHT OF 5KG,LOSS OF APPETITE,RAISED ESR 65,AND SEVERE BACHACHE INCLUDING PAIN RADIATING TO THE LOWER LIMBS.
HE HAS TAKEN ATT FOR 2MONTHS INH+RIF+PZA+ETB,WITH RELIEF IN FEVER,BACHACHE,LOSS OF APPETITE.ESR NOW IS 25.
WHAT IS THE ATT REGIME RECCOMENDED BY YOU ie WHAT SHOULD BE THE DURATION OF THE INTENSIVE PHASE(4 DRUGS) AND FOR HOW LONG SHOULD THE CONTINUATION PHASE (2DRUDSie inh+rif) LAST
Dr Arun Pal Singh Reply:
July 28th, 2010 at 4:55 pm
@kiran garg,
I generally follow2 +10 for osteoarticular tuberculosis. Intensive ohase can be prolonged if the disease is severe.
P.S. Please do not use all capitals in your comment. It looks quite bad and repelling.
Thank you for the reply. She was operated upon and a brace was implanted for D5. Unfortunately, we’ve been advised L11-12 also requires a similar surgery in about 6 months. All in all, just in the nick of time since the disease seemed to have spread very soon (within 2 months). Not sure if we can go ahead with it considering her age. We’re really frustrated at the first few specialists for not having run enough diagnostic tests (contrast MRI was only done at our insistence after two others did not help the doctors arrive at any conclusion).
Dr Arun Pal Singh Reply:
August 2nd, 2010 at 2:53 pm
@Raghu,
All the best. Take care.
Dr, I am so glad I found this site as I am in dire need of advice.
My husband was diagnosed with Spine Tb in April this year. The diagnosis was based on MRI and biopsy.
Treatment started on 2 April with the usual 4 tb medicines. At that point of time his condition was such that he could not move at all the pain was unbearable. The infection was in L5-S1. These vertebrae were highly involved.
Another MRI at 2 months showed a cold abcess. We did not want any implants, so the neurosurgeon operated for drainage of the abcess. Surgery was done and slowly the stabbing pains in the legs decreased in intensity.
It is two months now since drainage surgey and he is still on R-Cinex, Ethambutol, Pyzina and Zanocin.
His mobility is much better than what he was in April. But the pain in the legs is still there whenever he tries to walk. In all he has been on bed for 4 months now. He makes some effort to walk but we do not want to aggravate the pain so most of the time he is lying down.
I am very woried. How much time will it take for him to be fully mobile? Any other tests need to be done to assess the progress?
Thank you for your time and effort.
Dr Arun Pal Singh Reply:
August 8th, 2010 at 9:11 pm
@Neenak,
The treatment is continued at least till one year of duration.
It is very difficult to predict the progress in particular patient but in my opinion give him couple of months more.
Let me know how does he progress.
i have been detected with TB in spine on June 2010, i am on AKT4 medicines + Pyridoxine. the affected region os L1 L2 an D1 D2, one of the vertebra is almost collapsed. they advised rest, and improvement shud b thr within 6 weeks, …nw my limbs r getting weak, not able to life my leg, but the condition is neither inproving or getting worse, its stable since a month.bowel movements r normal……. ..
could thisb bcos of the nerve getting compressed or so? wud you advise surgery, or will i recover slowly by just relying on tablets n physio? if surgery, which is th ebest hospital in kerala / south india i can go?
thnx jen
Dr Arun Pal Singh Reply:
August 13th, 2010 at 5:01 pm
@jen,
TB spine with neurological involvement [Weakness in limbs] should be considered for surgery if there is no objective improvement in the weakness in spite of rest and medication.
Please discuss it with your doctor.
One of the primary things to establish is that diagnosis is of Tuberculosis is certain.
I hope that helps.
Thanks Dr.Arun for your valuable information regarding the ATT regime in osteoarticular TB.
I would also like to know that when should a second MRI done to document the clinical response of ATT(if at all it is required).besides MRI what are other radiological and hematological tests that should be carried out during ATT treatment to monitor the progress of clinical response.
Also Dr.Arun where are you based and is it possible to visit you in person for professional advise.
Dr Arun Pal Singh Reply:
August 13th, 2010 at 5:19 pm
@kiran garg,
If the diagnosis of Tuberculosis is certain/confirmed I do not think there would be a need to confirm the response as the response would be obvious clinically.
Patient’s clinical condition, ESR, CRP and serial xrays are frequently used to monitor the progress.
However if one wants to see MRI response, I think it is prudent to wait for 6-8 weeks before another MRI.
I am in a place called Mukerian in Hoshiarpur district of Punjab. If it is feasible a meeting can be arranged.
Dear Sir,
My wife has one tumour at upper side of neck. We have tested this tumour at lab. Then doctor has advised to take following tablets. AKT – FD & Gaity – 400 for one month. Which type of this drugs and why they take.
Before two months She has pus in her teeth. We have remove her teeth at dentist. But after removing her teeth mouth were swelling for more than 40 days. That time this tumour was also sweling. Pl advise me about this tablet. Dr said us its may be TB. Now this tumour size is reduced more than 25% of its original size. Her Hemoglibin was 6.8. Now it is 9.6.
Dr Arun Pal Singh Reply:
August 28th, 2010 at 9:49 pm
@santosh,
She has been put on antitubercular medication and as per your account is improving. Good luck.
thanks Dr for your advice. Now my ESR is 12 mm/ist hour reading, I can walk now without pain. Weight has increased 3 kg.So I continue ATD with consultation of My Ex teacher who was Prof of Medicine.Sir advised to do Mantaux to establish the diagnosis ( though Its role is now unsatisfactory),and it was positive.vague discomfort in lumbosacral zone still persists. If increases, I must do MRI as per your advice. Serum calcium done which was low 5 mg%.Thank you once again for your response
Dr.P.P.Chowdhury
Dr Arun Pal Singh Reply:
September 2nd, 2010 at 5:39 am
@Dr.Partha Pratim Chowdhury,
All the best. Take care.
Thank you once again Dr.Arun for your valuable advise regarding monitoring the progress of spinal TB when on ATT.I shall contact you soon so a meeting can be arranged in person.