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
Hi Dr. ARUN,
HOW R U?
TODAY AFTER 30 DAYS OF ATT MY ESR IS 18 FROM 46 TO START WITH.
WHAT WILL U SAY?
DR.BHALLA FDK
Dr Arun Pal Singh Reply:
November 10th, 2010 at 10:36 pm
@Dr.sanjiv k bhalla,
There is reduction of the inflammation and quantum of infection appears to be reducing.
All the best.
Hello Doctor, I am suffering from TB of the spine, my legs are paralyzed, is that cause by the TB. and after my complete TB drugs intake will my legs be corrected i.e will I be able to work?
Dr Arun Pal Singh Reply:
November 27th, 2010 at 7:09 am
@Happy,
The answers to your question would vary depending upon your level of TB, MRI picture, your response to treatment etc.
Did you talk to your doctor? What have you been told?
Hi Dr. Arun,
I had a surgery for pott’s spine around 7 years ago, now i am completely alright except
that i feel a little lower back pain sometimes, what is you view on this and also what are
the exercises i need to follow in order to avoid any future risks.
Dr Arun Pal Singh Reply:
December 21st, 2010 at 2:33 pm
@shanthi,
Minor backpains are common after Potts spine. But it persists or worsens, you need to see a physician to rule out any resurfacing of infection.
Back strengthening exercises should help you in absence of infection.
Dear sir,
I m suffering from TB in L2 – L5. I m already taking medication for the last 1 month. Some doctors are advising me to go for operation, since there is a chance of the bone collapse. Please do advise me how to be sure to go for surgery.
On the other hand, will my bone decayed will recover, how long time it may take…
Dr Arun Pal Singh Reply:
December 21st, 2010 at 2:38 pm
@Jayed Bin Jasim,
Need for surgery is dependent on many factors but strongest is presence of neurological deficit i.e. presence of weakness in lower limbs, difficulty in passing urine or emptying bowel.
You would have to provide me complete information on the problem and send xray to contact [at] boneandspine [dot] com.
Generally, in absence of neural deficit, surgery is not required in Lumbar spine.
Hello Doctor
My Mother 56 Yrs ld , suffered from Bone TB , of Spine , 1.3 yrs back , Now the MRI showed nearly complete recovery , ESR is 29 , all symptoms like Weight loss, Fever have subsided 8 months back.
ISSUE:ACUTE STIFFNESS IN LEGS , DIFFICULTY IN WALKING , UNDERGOING PHYSIOTHERAPY, BUT NO CHANGE IN LAST 6 MONTHS IN LEVEL OF STIFFNESS,
KINDLY ADVICE.
Regards
Rohit
Dr Arun Pal Singh Reply:
January 12th, 2011 at 2:23 pm
@Rohit Bahl,
Please avoid writing in CAPITAL.
As for as your problem is concerned, you did not provide full info.
Did you have any weakness in the limbs at the time you had tuberculosis.
The way you describe your present condition, it seems like rigidity which is consequence of neural weakness.
When did you see your doctor?
Hello doctor,
I was diagnosed with spinal tb 7 months bCk . T11,l4,l5,right sacrum. I’m under treatment for it.first 2 months I took emb,pza,inz,rmp.after 2 months it was reduced to inh and rmp.I was showing very good improvement.
In my 4 th month I started to sit for long hours , walk for long hours like 8 hours.I did a squatting on November 3 rd .after that I’m experiencing pain,prick in right sacral, thigh,knee.
Please can you guide me.
Regards,
Kavitha
Dr Arun Pal Singh Reply:
January 22nd, 2011 at 1:30 pm
@kavin,
Minor symptoms often occur during the course of healing. If the symptoms are persisting, get evaluated by your treating doctor.
Hello Doctor
First , thanks for replying to my query
My Mother suffered from Bone TB , we see the doctor( Bone TB Doctor) regularly every 1-2 months , but stiffness is showing no improvement .
No limb weakness before Bone TB .
So when you say Neural weakness , so that means , now we need to start some other mediciens , all anti-stiffness mediciens given by doctor are not working .
Regards
Rohit
Dr Arun Pal Singh Reply:
January 22nd, 2011 at 2:23 pm
@Rohit Bahl,
She needs to be examined and evaluated for neurological loss, followed by determination of the cause of weakness and possible treatment.
Please talk to your doctor and if that does not help, get another opinion in person.
HEL;LO DR SAHIB
I WANT TO KNOW HOW DOES HEALING OF VERTEBRAE OCCURS IN CASE OF DORSAL SPINE TB—– I MEAN BY WAY OF CALLUS FORMATION OR TISSUE HEALING?
Dr Arun Pal Singh Reply:
January 22nd, 2011 at 12:48 pm
@DR.SANJIV BHALLA,
Please avoid writing in all CAPITAL letters. Does not look nice.
There would be no callus formation. The healing is confirmed by observing relief in symptoms, labortary parameters and radiological changes like decrease in fuzziness of vertebral margins and increase in density of the bone.
Hello Sir,
I am a 31 year old female , I have been diagnoised with TB in spine around 3 months ago.I have been on medication since then. The MRI taken 15 days ago says the infection is reducing. From when do you think i can start exercising ? Can i start taking walks and physical execercises. Doctor informed that i will be put on physiotheraphy shortly. why is physiotheraphy needed , is it very painful ?
Thanks in advance for your replies.
Indira
Dr Arun Pal Singh Reply:
February 4th, 2011 at 7:26 am
@Padma Ram,
Physiotherapy is needed to strengthen your musculature.
Please follow your doctor’s advice in regard to physiotherapy.
I have been diagonesed with TB Spine in May,2010 and had taken AKT4 for 4 months. Now am on AKT2 for 4 months. I need to sit for 10-12 hours a day and am getting pain in lower and middle back. Please suggest ways to relax back while sitting and sleeping. Is lying on stomach good?
Dr Arun Pal Singh Reply:
February 12th, 2011 at 2:31 pm
@Sangeetha,
You need to take strength building exercises for your back after consultation with your doctor and you need to do them under supervision of physiotherapist.
You can lie on the stomach if it makes you feel better.
My father, who is 90, was diagnosed with spinal TB last September and it was found that two of his lower vertebraea (D10-D11) had suffered severe destruction. He was placed on a course of anti-tubercular treatment (AKT4 to January and then AKT2 to March). Within a month or so he was no longer in pain and slowly thereafter he started sitting up and moving about with a walker and wheelchair, always wearing a custom-made back brace and with help. He also had physiotherapy. However, in the last week he has again been bedridden suffering very severe backache and pain around his midriff. What might be causing this? A recurrence of the TB or compression fracture(s)? He is continuing with AKT2, taking calcium and other bone strengthening supplements as well as painkillers.
Dr Arun Pal Singh Reply:
February 22nd, 2011 at 2:05 pm
@James Chiriyankandath,
In such cases one needs to rule out reactivation of the disease. If that is not there, common cause of backache after tuberculosis is malalignment of the vertebra following destruction resulting in alteration of the mechanical forces.
Physiotherapy helps the patient in these cases.
Dear Dr Singh,
My dad (Age 69 years) has been diagonised with possible TB of the spine (the space between D9 – D10 shows significant compression).
The AKT 4 therapy has started since the last 6-7 days and there is significant reduction in the pain whihc was present throughout the day earlier before this treatment.
Since the last 2-3 days ,my dad has been complaining of wobbly legs specifically ,the left foot .But when he lies down ,he is able to lift the leg ,bend it normally like the other leg.
Also need to mention that he is diabletic(since the last 4-5 months) which was detected after a bout of malaria and has glaucoma.
I also need to mention that he was extremely active and was doing Yoga for the last 30 -35 years and apart from poor vision enjoyed robust health and a very healthy appetitie.
When do you think he can get back on his feet and that are the precautions we have to take at this juncture.He has been advise to wear a hyper extension brace .
Thank You!
Venkatesh
Dr Arun Pal Singh Reply:
February 22nd, 2011 at 2:08 pm
@Pachu,
If he is complaining of weakness in legs, get him examined for motor power. If he has neural deficit, the treatment would follow a different course.
The MRI reports says partial distruction, collapse with abnormal signal changes invoving L4/L5 vertibral body, associated with pre/paravertibral, epidural and left psoas abses. on 5-2-2011 aspiration of left psos absces was done about the 15ml of the puss was asperated.I have been diagonised as spondylodicitis kochs on 5-2-2011.i have been given with Akt4. Now i could not walk freely feeling with muscular cathing,as per dr advice iam wearing Knight brace AS on today the treatment of Akt4 is only 15 days. Meanwhile yesterday the ortho doctor has adviced me to take 1 gm of streptomycin IM for only 7 days. My apprehencion is that once the streptomycin has administrated it requires min 60 days treatment, the doctor says only 7 days treatment required to see the progress. Is it correct way of treatment, only 7 days treatment may create resistance of drug, please enlightment me in this regard
Dr Arun Pal Singh Reply:
March 8th, 2011 at 12:22 pm
@prashanth,
I have noot heard about any regime that includes steptomycin for 7 days nor it is indicated in the standard regimes.
Please talk to your doctor.
Dr Arun Pal Singh Reply:
March 8th, 2011 at 1:01 pm
@prashanth,
That is not included in standard regimes. Please speak to your doctor.
Had a kidney infection after traveling over seas, urine cultures were negative, I was in severe kidney pain till one Dr decided to prescribe keflex. The kidney pain immediately went away after 5 days. Right after stopping the antibiotics I started having spine pain along with other bone pain which I had before with the kidney infection. Only new symptom was that my back pain was and still severe. I did an MRI, Bone and Gallium scan and Xrays, all studies were normal. I also had many lab work done, and everything is normal, including Autoimmune and Arthritis. Blood cultures were negative as well.
My back pain is getting worse, along with night chills, heart racing and pain in other bones including my jaw. Iam begging my Dr to start an antibiotics either with IV or IM and hes hesitant to treat something blindly. MY TB skin test came back positive and hes not sure if its TB or a vaccine that I had when I was a kid. Do you think this can be TB and what do you recommend when nothing is showing up on lab work? I really feel I should start some sort of a course to prevent any possible infection from damaging my back and bones.
Dr Arun Pal Singh Reply:
March 8th, 2011 at 1:22 pm
@Bass,
It is a difficult situation for the clinician when patient has symptoms and every investigation is normal.
Do you still have symptoms? Any update?
Im certain its an infection and had something to do with my kidney infection, just ot sure what kind of bacteria. Is there an Intramuscular antibiotics that can treat TB and Gram negative and positive bacteria at the same time. Thanks for your time. My email is [moderated - Not Allowed] Anyone may send me an email if they please and appreciate any response.
Hello Doctor,
My father is detected to suffer from Tuberculosis in the spine today. The affected area is L4-L5. He is 52yrs old and has blood sugar. When we hospitaised in some 15days back his lower body was semi paralysed. He had numb sensation from his lower abdomen and had great difficulty in emptying bowel. Though no treatment for Tuberculosis has been started yet he can lift his legs. but still he is unable to walk.
Is this stage curable or do the symptoms show of an acute tuberculosis?
The medicines given to him are:-
Lyrica and Glycomer SR 500
Please help
Dr Arun Pal Singh Reply:
March 8th, 2011 at 1:23 pm
@Sanganika,
If he has tuberculosis, he should be put on complete bed rest and antitubercular chemotherapy.
How is he now?
my friend aged 24 /F is suffering with severe lumbago since 2 months & ESR is 22 mm/1st hr & the phisician is suspected as KOCH’S SPINE .What other investigations do she need to confirm the same
Dr Arun Pal Singh Reply:
March 9th, 2011 at 7:47 am
@suneetha vaka,
Please see a spine specialist who would invesitigate as required.
i ws operated in Aug 2010 for Koch’s disease ( spinal TB in D11 and D12). before that i was becoming almost paralysed waist down…………. now they hav fixed a metal cage to support my vertebra. i was on bed rest until nov 2010. as of now i am able to get up and walk but i hav lost balance to walk and still need the help of a walker to walk around. its the lower part of the body for which i find dfficcult to balance and stand on my legs. i have sever pain in my knees and thighs when i try to walk. Doctor has advised to be patient and let it heal with time- please let me know how long it would take if i need to be able to walk like before. i could provide you any more details of my illness if required. Thnx, Jen
Dr Arun Pal Singh Reply:
March 9th, 2011 at 7:49 am
@jeny,
It cannot be predicted and varies in different individuals and could take more than a year in some cases.
Anyways, you seem to be making a fine progress.
Thanx doctor for you reply. My dad is in complete bed rest but he is not given any chemotherapy instead some antitubercular injections and medicine are being given to him. Though he is recovering day by day and is able to walk holding on some support but their are two major concerns regarding his health-
1. His blood sugar is increasing day by day. Inspite of increasing the Insulin doses there his blood sugar is increasing almost everyday.
2. From yesterday he is feeling dizzy time to time specially after a walk.
Are these symptoms normal with such patients or is it a symptom of deterioration?
Dr Arun Pal Singh Reply:
March 31st, 2011 at 10:07 am
@Sanganika,
Antitubercular chemotherapy consists of injections and oral drugs. I think he is being treated on right line.
How is he now?
Pain started to spread rapidly up the spine, did another MRI and still was negative. Dr put me on rocephin IM after 8 days the pain at the top started to get much better but still have severe pain in the lumbar. Not sure if the recephin shots are a coincidence in getting better. I really feel they helped my back. Will continue taking the shots daily. I hope they find something soon. Thank you for letting me participate.
sir,
my mother is suffering from back pain since six months. recently the pain became severe and doctor suggested to go for MRI. the report is SPINAL TB. docotor suggested to go for spine surgery as 60% of the bone( D12, T1) are damaged. if neglected the stress is fallen on the remaining 40% of the bone and there is a chance of bone brekage which leads to non – functioning of the legs. in the meanwhile doctor suggested to use AKT – 4, BENADON, ULTRACET for pain relief. i request you to kindly suggest me what are the precautions and safety measures that are to be taken after surgery like doing her routine activities like house hold works, walking without any support, climbing steps and so on. i had a doubt wheather surgery is required for this case or it can be cured through medicines.
Dr Arun Pal Singh Reply:
March 31st, 2011 at 10:12 am
@shankar,
She would be on bed rest for long time. Did she undergo surgery?
i was suffering from tb spine but now me recover 3 yrs left now. i took medicine 1 yr as my dr suggest .now me getting again problem my legs knees r paining lot i cant sleep also wid that pain . i am taking medicince pain tablets n calicum tablets but for few hours iam relief with pain then agian it started my pain. now i chck my ESR it 30%. dr can u tell me dat this tb spine can come back after 3 yrs completed. im 30 yrs old.me wating for ur reply.
Dr Arun Pal Singh Reply:
March 31st, 2011 at 10:38 am
@anitha,
recurrence or recrudescence is known. Please get in consultation with doctor to get investigated.
Dear Sir,
My Jija ji (living in Thane-Mumbai), has been diagnosed with spinal tuberculosis, a week back and his MRI report, yestday tells something like,
“abnormal marrow changes seen at d7 d8, vertebral bodies with eroisiols the marrows changes are hypointtense on t1w hyperpoint on t2w. Focus area seen on at D6 with associated abnormal pre. paravertebral abscess seen from d6 to d8 on left side. Infective sponlysis at d7 d8.” (may be spelling mistake or words lost as I retyped it what my sister told me at phone)
He sometimes have backpain, not severe. he is on paracetamol tablets. and some injections and full bedrest at hospital.
Doctor who is managing the case says surgery to support the spine would be a good option. But we are not very good with the idea of spine surgery. Isnt there any other option !!
With kind regards,
Manish Dev
Dr Arun Pal Singh Reply:
March 31st, 2011 at 12:00 pm
@Manish Dev Vishwakarma,
This reply may be delayed for you. I am sorry for the delay but there were certain things that kept me occupied.
How is he now? Did he undergo surgery?
Even though my MRI and all studies were normal, I now have an abscess in my lumbar and upper spine. Im in massive pain and for some reason the ER system here in jersey doesnt qualify me to be admitted. I will keep screaming till someone helps me before things get worse. first I had spine pain that wasnt showing up on any of the studies. Now I have two lumps in my spine, not sure if this correlates with TB or other bacterial infections. Taking the rocephin shots, doxycycline and was prescribed bactrim today but scared to take it. If I knew it would help me I would take it but after reading some of its serious side effects and Drs are unsure what theyre treating I decided not to take it. will go back to the ER if things get painful again or if the lumps dont go down. I hope they admit me and properly take care of whatever is going on in my spine. Lots of twitchings going on, was worse before the BX though. Also had other bone pain which seems to be going away after rocephin. Pain was in my shins, knees and other areas.
Thanks for this great thread.
Dr Arun Pal Singh Reply:
March 31st, 2011 at 12:05 pm
@Bass,
Abcess means infection and since you had an overseas travel, tuberculosis appears a possibility.
Consult your specialist.
Dear Sir,
I have been diagnosed with TB in S1-S2-S3. I started my treatment on 5th January 2011,since then i am on AKT4 and multivitamins.Doctor advised me bed rest of 6 weeks and after that i joined the office in Feb.
Dr told me to have regular checkup of Liver and Kidneys functions along with CBC and ESR. All the reports are normal,initially ESR was 31 but it has come to 11.
Only Problem which i am having of High Uric Acid around 8.2 because of which there is severe pain in ankles with Swelling.Initially along with AKT4 i was taking Febustat 40 and now it has been changed to zyloric 100 twice a day.
I responded well to AKT4 as the pain had gone completely from lower back.
From last two – three days i am feeling severe pain in both hips and unable to walk and sit.If i stand ,i feel little relax. I asked my dr about the problem,he told me that Uric Acid is causing all this pains and becuase of severe pain in Ankles more pressure is coming on lower back.
My Next MRI after starting AKT4 is due in end of march.
I request your opinion on pain in hips and ankles.I am little worried about the TB. Is it again started in the lower back?
Dr Arun Pal Singh Reply:
March 31st, 2011 at 12:59 pm
@Vijay Jain,
I am not sure. Probably there is a spasm that causes pain in the hips.
Sometimes the pain could involve multiple joints in TB but that is rare.
I have a friend who has been diagnosed with TB of the spine
Is this contageous
He is having really bad head aches
What is the treatment for this
Dr Arun Pal Singh Reply:
March 31st, 2011 at 12:53 pm
@waylin,
Get in touch with a doctor please. Most of your questions are answered in the article itself.
Unless it is affecting his lungs too, spinal tuberculosis does not spread from one person to other.
Hello Dr. Arun,
My mother is 51 years old and she is suffering from TB in spine and we have started medicines as prescribed by doctor. He rectified it with the x ray and MRI. She is having infection nearby neck. My question is how much time does it will take to recover, doctor has asked complete bed rest for one month and after recovery what precautions i will have to take ?
Dr Arun Pal Singh Reply:
March 31st, 2011 at 12:51 pm
@Abhijeet,
It would depend on the level[s] affected, severity of the disease etc.
The best person who can guide you on this is the doctor you are consulting.
Thats so much Dr. Singh, I had a quanteferron gold test and it was negative, also Im responding to rocephin, I now have a picc line and getting 2000mg iv daily. Can I rule out TB with the Gold test and for the fact that Im responding to rocephin? This all originated from a kidney infection that wasnt showing up in urine cultures so it stayed in me for a while before a dr treated me with keflex for 10 days. Once the kidney pain went away I started having minor back pain which progressed to severe.
Facts:
Bacteria not showing up in normal cultures. ( I wish I knew what those can be)
Bacteria or pain in the kidneys went away after 10 days of keflex.
Bacteria in the spine is resolving slowly with Rocephin 2000mg iv.
Negative Quanteferron Gold test.
Positive skin test <18mm
With these facts can I rule out Spinal TB?
Thank you for your support Dr. Singh, I cant get that where Iam.
Dr Arun Pal Singh Reply:
April 11th, 2011 at 1:12 pm
@Bass,
It is good to know you are responding.
Quntiferon Gold test is 99% specific. That means it picks up tuberculosis with 99% accuracy. But there is limited data on accuracy amongst persons with recent exposure.
Skin test [ I assume it was Mantoux] is again non specific and reading of that magnitude can mean recent exposure too.
But all that does not translates into presence or absence of an active tubercular disease.
From what you describe, established spine abscesses, I think tuberculosis cannot be ruled out as such.
Fluid aspiration from your abscess and its lab investigation can help in confirmation of the diagnosis.
All the best.
hello sir,
my mother name is Rita sinha suffering pott”s spine tubscular lymphaditis she was not even stand on her legs she was in treatment of aiims she used second line of medicine of tuberculosis as prescribed by aiims she was taking drugs like R-cinex, kanamicin, cycloserine from 1 and half year but she was not cure yet.
accordingly MRI
the cervical,dorsal and lumber curvatures are fairly maintained.
the inter vertebral disc space at D6/7 is lost and there is mild collapse of D6/7 vertebrae
sir please give me suggestion what i will do and which medicine should be given to her make her cure?
Dr Arun Pal Singh Reply:
April 11th, 2011 at 1:42 pm
@kumar sunny,
Why she is on second line of drugs?
Is there any resistance to medication?
What does her treating doctor tell you.
Hello Doctor
Am writing for third time , its regarding my Mother, 57 years Old , suffered from Spine TB , had taken anti TB medicines for 1.5 years, Now the anti TB medicines have been stopped, infection cured as per doctor
But the problem is the stiffness in legs has increased , and shows no signs of improvement, we have also contatced neuroligist , but no improvement.
Is there is chance of Legs getting paralysed, or situation getting worse, se can move , but balace is not there……
Regards
Rohit
Dr Arun Pal Singh Reply:
April 11th, 2011 at 12:19 pm
@Rohit Bahl,
What is the casue of stiffness? Is it spasticity or it is decreased mobility of the joints? I do not have enough info to deduce from.
Dear doctor
my friend was diagnosed with bone tb of spine recently , pls advice what are the precautions he should take and what are the risk that can occur because of this .
is the treatment very costly as he is a very poor fellow ?
what are chances of recovery , how much time and how much recovery is possible ( would he able to work and support his family again)
Dr Arun Pal Singh Reply:
April 29th, 2011 at 6:09 pm
@vivek chawla,
The treatment is available across DOTS centers free of cost. For other things the treating doctor would have better and specific answers.
Dr. Singh, my mother has just been detected with spinal TB, after being in pain since October 2010. The doctor has advised a biopsy and then will prescribe medicine. She’s 60 years old, is it likely that she’ll get cured with only medicine and won’t need spinal surgery? Also, does she require complete bedrest?
Dr Arun Pal Singh Reply:
April 29th, 2011 at 6:18 pm
@Radhika Kalra Choudhry,
TB in most of the patients is curable. Whether she needs only medication or surgery in addition need to be decided by your treating doctor.
Complete bed rest is required in cases with neural deficit.
Hi,
I had intense Back ache for two mts. last yr Jul & Aug.
most specific problem was unable in side to side shifting in bed.
MRI – Signal changes in T9, endplate of T 8, some pre & para vertebral collection (6 mm), Partial collapse, less than 1/3 of vertebra, Anterior wedging.
No Biopsy done.
Bed rest & ATT (4 drug full dose) started, pain relieved in 2 mts. ie no Analgesic required.
After 6 mth. I started light activities, there was occasional increasing & decreasing pain, which mostly relieved by rest.
monthly MRI showing constant improvements, collection decreased, signal start changing, CT scan showing some sclerosis.
Now it almost 9 mths. Still all 4 drugs. some told to take up to 1 yr.
But still one in 10 days I have intense pain & stiffness if do not take rest after 4-5 hrs.
how long it will take me to normalise, forward bending, side to side shifting in bed. I sit straight but it causes more stiffness.
What to do ?
Dr Arun Pal Singh Reply:
May 13th, 2011 at 8:34 pm
@Sunil Jain,
Things would get better with passing time. Talk to your doctor- You should be on two drugs by now.
Hello Doctor,
I had Spinal TB, at least that was surmised due to that fact I responded to the treatment for TB. There was not one single postive culture from the infected sites except for the skin test. My doctors were very interested in me. To this day they would tell you they think I had spinal TB. My elbows and arm muscles ache constantly. I am beginning to wonder becuase these pains have laste about 6 months. Doctor would there be any correaltion? I was diagnosed in late November of 2009 with spinal TB.
Thank you
Gene Johnson
Dr Arun Pal Singh Reply:
May 13th, 2011 at 8:35 pm
@Gene Johnson,
What was the level?
Hello Doctor
Yes , cause of stiffness is spasticity, feeling of contracting muscles has increased , walking balance is not there ……..
* What is the casue of stiffness? Is it spasticity or it is decreased mobility of the joints? I do not have enough info to deduce from.*
Regards
Rohit
Dr Arun Pal Singh Reply:
May 13th, 2011 at 9:11 pm
@Rohit Bahl,
An increase in spasticity probably means increase in compression and cause should be looked for.
Hello Once again Dr. after 35 days of Rocephin my one disc got better but got 5 other painfull discs above. My dr stopped rocephin and now has me on levaquin and tobramycin. which are now for 15 days.
I was very stiff and couldnt flex back or forward and in severe pain, now after the tobra and levaquin there is some mobility. I will stop the tobra tomorrow as it cant be given long term.
My question is if I had tb of the spine, would the levaquin or tobra have an effect on tb?
to remind you again I had a kidney infection for three months or so because urine cultures would always come back negative, finaly was treated with keflex and right after started to feel the back pain.
Im looking for thebest imperical treatment when a pathogen is not identified in Osteo. My MRi are still clean even though I had so much pain at one point. Maybe I should repeat my quanteferon tb gold test to rule out a tb for sure. First one is negative. I wonder why my kidney infection never showed up in urine cultures, thats what destroyed me to this point. After the tobra, the dr is thinking maybe zosyn or meropenim, but require 4 times a day dosing which is an abstacle in the states.
How would you treat an unkown pathogen impericaly. Such a horrible position to be in.
Even linezolid was an option to cover all gram positive bacteria, but i read it doesnt work well for ostea and also a bacteriacidal not static should be used to osteo.
Sorry for the long message just adding another odd mystery to the thread. Great thread and has great information.
One last question, is it normal for a spinal infection not to show up on mri? All I have is spondelithesis and theyre not taking it as an infection.
Dr Arun Pal Singh Reply:
May 28th, 2011 at 2:02 pm
@Bass,
At one point you mentioned about lumbar and thoracic spine abcesses. When you say MRI is clean, do you mean they have regressed!
Was any organism isolated from that abcess? Was it tested for tuberculosis.
When was spondylolisthesis detected? Initially or it was found during course of treatment.
How are things now?
Let me rewrite my questions in an organized fashion.
Should I conduct another Quantefiron TB gold test?
Would the tobra, rocephin or levaquin have any impact on mycobacterium? (trying to rule out TB)
Is it normal for MRI studies to come back negative with a spine infection? Its been 3 months now with pain.
If its not TB how would you empiricaly treat an unkown pathogen?
The pain initially was one disc and now traveling to other discs, is this a behavior of an infection.
What kind of bacteria would not show up in urine cultures.
Were suspecting Pseudamonas and is why he added tobra and levaquin. Gave me some relief in 15 days but far from painless.
Dr Arun Pal Singh Reply:
May 28th, 2011 at 2:11 pm
@Bass,
I answered few of them in last comment.
For empirical treatment of a bacterial infection, broad spectrum antibiotics are used.
But if it is an infection, there should be some destruction of tissue somewhere.
When you say pain is in the dis, what do you want to convey.
How can you identify the pain from disc.
I also went to your firstmost comment. Here are few lines
Had a kidney infection after traveling over seas, urine cultures were negative, I was in severe kidney pain till one Dr decided to prescribe keflex. The kidney pain immediately went away after 5 days. Right after stopping the antibiotics I started having spine pain along with other bone pain which I had before with the kidney infection. Only new symptom was that my back pain was and still severe.
Why do you say you have kidney infection and pain was from kidney?
Was any imaging done which suggested kidney changes? I mean you label it as kidney pain! Why?
What were you told?
Im also having so much stiffness, whatever bacteria I have it has traveled from one disc to many. I also feel tingling on the skin and 3 weeks later i start feeling the bone pain. Its unreal and very hard to find out whats going on. I just had another Quantiferon TB Gold test and also Schistoma IGG test. I hope something can come back positive. I stopped the tobrmaycin and now on Levaquin, sucks treating things this way as the tobra hurt my ears. I hope one of these tests comes back positive. By the way this happened after drinking sugar cane water from street vendors. Can TB or Schistosmiasis live in such environment and attach its self to my kidneys then spread to my spine. All those who got diagnosed be very pleased as you can be treated.
Pet scan is the next test, what you think of this test for infections Dr?
My mother is suffering from pott’s spine disease, since last November. she was on bed completely for 3 months, as adviced by the doctor and is taking proper medicines as well…how long the medicines have to be continued as she has been adviced to continue taking it for 16 months more??she’s working and has joined her office now , but due to customer dealing she has to sit for too long, will this effect her spine again?
Dr Arun Pal Singh Reply:
June 9th, 2011 at 3:10 pm
@rohini,
Prolonged sitting puts load on spine and is advised against. She can take frequent breaks.
Therapy has been recommended as long as 18 months.
i was diagonsed some fluid on D12 vertibara through mri test on 20.04.11 esr was 115 and AKT4 course started on 23.04.11.on 23.05.11 esr was 70 and appitite and weight increase is there.There is slight pain around waist Doctor advised rest bed for rest for two months one month erliar and month on 23.05.11.Wil i be to join my duty after that
Dr Arun Pal Singh Reply:
June 10th, 2011 at 2:48 pm
@Harcharan singh,
It is very difficult to speculate. Hope for the best and carry on with your treatment.
Hello! DR.
is spine t.b communicable? if yes to which extent? what precautions to take?
please reply.
Dr Arun Pal Singh Reply:
June 9th, 2011 at 3:21 pm
@akansha gupta,
Per se it is not communicable.
Thank you for your reply..
Initially I thought it was an abscess but it was just a bulging disc that was only visible when I bend forward. But on an MRI this disc appeared normal or now I have 6 minimally bulging discs. I finally had an abscess discovered on apr18th, the MRI stated diminished soft tissue from infiltration involving the subcutaneous tissues at the T12 through the L2 levels. In this area I had felt burning and the skin was very tender to the touch. When I started the levaquin it vanished and was too late for a biopsy ( poor medicine in America).Also Trace grade 1 spondylothesis on Lf-s1. Which werent there prior.
The levaquin is helping me but I cant tolerate it, the rocephin helped one disk while I got damaged on 6 other disks. Initially my pain was in the disc right near my right kidney and the disc was bulging to the right only when I leaned forward. From this disc the pain has spread up slowly skipping a few discs in between and did the same going down.
Im responding to the levaquin for sure, I was in agonizing pain and couldnt bend forward or backwards in my thoracic spine and can be felt when trying to bend while sitting down. Now its better after the levaquin. I feel had I taken the levaquin with the rocephin in the beginning of treatment while it was only 1 disc, It wouldnt have spread up.
Update I did a second quanteferon TB gold test and it was negative. ( I read that although an accurate test, mishandeling the specimen is a big risk for false negatives. overfilling or underfilling the test tube is a big problem. But two TB gold cant be wrong.
I also had a schistosmiasis AB that came back positive, I was excited at first to learn we may have found a pathogen but Im responding to levaquin for sure and schistoma does not respond to levaquin. so Im starting Treatment for schisto on tuesday but Im sure this isnt the problem. Im about to leave the US to another country to get help immediately, the folks here are not prepared to deal with my case and are happy to just prescribe pain meds and refferals to pain management physicians. Horrible place to get diagnosing, they need hard evidence before starting empircal treatment and at times that can mean watching you die.
I also had a spinal tap and that was negative for any cultures, which I was sure it would be.
Im not sure what else to do,
Im so lost, levaquin is buying me time not sure if it wil cure me, not sure if I should start tb drugs empricaly if any dr would prescribe them. I also did 18 days of tobramycin IV and did nothing but ruin my ears. I believe zosyn or meropem would be better emprical treatment options but no one is giving it.
Can schisto respond to levaquin at all?
Dr Arun Pal Singh Reply:
June 10th, 2011 at 3:01 pm
@bass,
I do not think levaquin acts on schistosomiasis but there are other drugs that do and I do not think if positive antibody for schistosomiasis means all you have is caused by that pathogen.
It might but then it just can be a additional finding too.
Hello doctor,
My father is diagnosed as potts spine of L5- S1 vertebra 2 months ago. He is recovering on ATT. But there is severe pain in his left buttock sometimes radiating to whole limb. Kindly help.
Dr Arun Pal Singh Reply:
June 14th, 2011 at 12:57 am
@fatimaa khan,
It means there is some kind of compression on the nerve.
Did you talk to your doctor?
I had severe kidney pain for a while, plus RBC were constantly in my urine. In the later stages of the kidney pain, I started to get shin pain and lots of muscle twitchings. Ater 15 days of antibitoics, the pain went away in my Kidneys and shins were getting much better. Right after that I started having spine pain. Kidney pain lasted 3 or mor eMonths before it was treated.
My spine started with 1 disc and now its spreading so much and fast, whatever it is its very aggressive.
Im also getting another lump above the tailbone, I called it an abscess before, but it doesnt sem like theres puss inside. Just getting swollen. Which the MRI labeled them as Infiltrated diminished soft tissue. I hope it gets big enough to do a biopsy. But what if its a bacteria that takes months to grow cultures.
I was hopping I had potts disease its the easiest to treat it seems. Entire spine now is almost in pain and its worse if I stop taking the levaquin but the levaquin is not enough to get rid of it completely.
Worse part is diagnosing this, especially in the States where not too many Dr’s have dealt with spine infections.
Dr Arun Pal Singh Reply:
June 10th, 2011 at 3:06 pm
@Bass,
If there is a swelling, there has to be an abnormal finding there, whether pus or infilitration per se.
If not biopsy, Fine needle aspiration cytology would do.
What happened to PET scan?
my question doctor is how lower limb paralysis related to tb of the spine?
How does the nerves get involved in this whole busines of tb infecteion
Dr Arun Pal Singh Reply:
June 23rd, 2011 at 11:41 pm
@chipo mufudza,
Behind the vertebral bodies lie the spinal cord and exiting nerve roots. There compression can occur due to a lot of factors like pus, disc, sequestrum etc and lead to paralysis
Updated MRI finding as of 6/16/201, Im planning on going overseas for treatment as antibiotics are very hard to administer in the states without cultures and they will not do blind biopsies.
Mild changes ( from 3/3/2011) of the lower lumbar facet joints are noted. ( I cant bend at the waste)
Mild loss of normal high t2 signal from the discs within the midthoracic ( exactly where I have my pain) spine.
Any relation with these findings to an infection Dr. Singh?
Thanks again for this support.
Dr Arun Pal Singh Reply:
July 9th, 2011 at 8:22 am
@Bass,
I am starting to doubt if it is a bacterial infection at all. I mean the picture does not fit the usual presentations of infection.
Your MRI pictures do not support an infection.
A persisting infection SHOULD bring changes that are picked up by MRI.
[Please note I am not qualified to make comments on your case as I have the information on patient and have not examined the patient. What your doctors say would be more relevant in your case]
Any update?
I HAVE BEEN SUFFERING FROM BACK BONE TB PROBABLY LAST 11 MONTHS, I AM HAVING TB TABLETS FOR LAST 6 MONTHS, BUT VERY LITTLE IMPROVEMENT. WHEN I STARTED TO TAKE MEDICINE I KNEW THAT I NEED TO TAKE THEM FOR LONG TIME, BUT I WILL FEEL AFFECT AFTER 2 MONTHS OR SO BUT NO LUCK. PLEASE ADVICE WHAT SHOULD I DO ? THANK YOU
Dr Arun Pal Singh Reply:
July 9th, 2011 at 8:24 am
@DEB SARKAR,
Please refrain from using all CAPITAL letters.
Also, you need to tell me the problem in detail. For example level of the disease, your symptoms and your reports.
Hello doctor,
I have been diagnosed with TB of the spine and lungs and have been taking medication for nearly 5 weeks now. For the last 3 weeks, I am having an irritating back pain. Sometimes the pain stays on the right hand side of the back and sometimes it revolves throughout. I am also experiencing stiffness of the back on both sides.
I don’t have any pain on the bones of the spinal cord. Doctor, do you think this pain is due to the medication that I am taking or is this something else? Can you give me an indication as to when this pain is most likely to go away?
Regards,
KC
Dr Arun Pal Singh Reply:
July 9th, 2011 at 1:46 pm
@K Chakrabarty,
What you are experiencing seems to be a radicular pain or pain from irritated nerve roots.
This occurs when nerve roots in spinal cord are compressed by some mass or other pathology.
Please discuss with your treating doctor.
I know Dr Sing even half the physicians here dont think its an infection. But the MRIs keeps coming back positive with changes in only a matter of 50 days. What really turned everyones head in the begining was one of the spine bones sticking out really bad and I couldnt walk. Now thats in and I have nothing to show for other then changes on the MRI. I stopped the levaquin and the pain was a nightmare. Now on bactrim and once again the pain is resolving. Why the facet changes exactly where my pain is, and also this is exactly where I had a burning sensation with a mass, that went away but turned into bone pain later. Again all this happened after a travel and after a kidney infection. I hope the bactrim keeps going. I see a new specialist on Tuesday. The mild loss of T2 signal is also where my pain is. Without antibiotics this area becomes torturous. One dr said the bacteria isnt in my spine but something that hugs the spine, cant remember the word he used. Well see what happens tuesday and will update if they ever do a biopsy and find out whats causing this. What a horrible disease to have in the spine, I wish everyone well, and I feel everyone’s anxiety looking for answers. I thank you for this site and allowing people like me to ask questions.
Dr Arun Pal Singh Reply:
August 5th, 2011 at 7:07 pm
@Bass,
Sorry for such a long delay in getting back to you. Any update!
Thanks for your appreciation. I hope you get well soon. It has been quite some time.
Dear Doctor,
Thanks for your reply but the second paragraph does not seem to be complete, can you please finish your sentence?
Regards,
KC
Dr Arun Pal Singh Reply:
July 10th, 2011 at 4:53 pm
@K Chakrabarty,
It is complete. The sentence had jumped up, so I have corrected that.