Tuberculosis of Spine

Tuberculosis scoliosis of spine withTuberculosis of spine was first described by Percivall Pott. He noted this as a painful kyphotic deformity of the spine associated with paraplegia. Since then condition is also referred to as Pott’s disease.

Tuberculosis of spine is the most common site of skeletal tuberculosis. It accounts  for 50 percent of the cases. Tuberculosis of spine occurs most commonly in  lower thoracic region followed by lumbar, upper dorsal, cervical and sacral regions in decreasing order of frequency.

Tuberculosis of spine  is also referred as  tuberculous spondylitis. Tuberculosis of the spine  used to be a disease of early childhood in the past. But with improved public health measures, this age incidence has changed, and adults are more frequently affected.

Pathology of Tuberculosis of Spine

The 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.

As the disease progresses, 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.

Sometimes there may be multiple vertebrae involved with multiple foci of involvement separated by normal vertebrae termed as skip lesions. The infection may be disseminated to distant vertebrae via the paravertebral abscess.

As the tuberculosis of spine progresses, vertebral bodies loose their mechanical strength as a result of progressive destruction under the force of body weight and eventually collapse  leading to an angular kyphotic deformity. The severity of the deformity depends upon the extent of destruction, the level of the lesion, and the number of vertebrae involved.

Kyphosis is most marked in thoracic 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.

Neurological complications may arise due to compression of the cord by the abscess, caseating or granulating mass, intervertebral disc or edge of bone c. 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 of Tuberculosis of Spine

The onset of is usually insidious. Initial symptoms are vague, consisting of generalized malaise, easy fatiguability, loss of appetite and weight, and loss of desire to play outdoors in children. 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. The patient may complain of inability to flex spine when  picking an object up from the floor. For doing this,  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 may develop.

When the lesion is situated in the cervical or lumbar spine, a flattening of the normal lordosis is the initial finding.

Tenderness is often present in the affected vertebral levels. 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 of Tuberculosis of Spine

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  are taken to rule out outer foci of systemic disease in case of a suspected person.

Initially, the vertebral body 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 conditions that may causes destruction and collapse of the vertebral body, narrowing and obliteration of intervertebral disc spaces, and paraspinal soft-tissue swelling. These conditions are bacterial infections of spine, leukemia, Hodgkin’s disease, eosinophilic granuloma, aneurysmal bone cyst, and Ewing’s sarcoma.

Treatment of Tuberculosis of Spine

As soon as the diagnosis of tuberculous of spine 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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Comments

  1. Rami Irani says

    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

  2. Dr Arun Pal Singh says

    Yes Rami! you are absolutely right. Clinicoradiological diagnosis is quite reliable method in endemic areas like ours

  3. analyndmdphil says

    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?

  4. Dr Arun Pal Singh says

    @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.

  5. bhawna says

    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

  6. Dr Arun Pal Singh says

    @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.

  7. deepali says

    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

  8. Dr Arun Pal Singh says

    @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.

  9. deepali says

    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..

  10. Dr Arun Pal Singh says

    @deepali,
    It is not an uncommon disease as such. The lumbar area is affected in few patients though.

    It is infection by Mycobacterium tuberculosis.

  11. [email protected] says

    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!

  12. Dr Arun Pal Singh says

    @[email protected],

    I think you need to visit your doctor in view of fresh developments.

  13. rani says

    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

  14. Dr Arun Pal Singh says

    @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.

  15. ishmeetking says

    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 ?

  16. Dr Arun Pal Singh says

    @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.

  17. ishmeetking says

    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 ….

  18. Dr Arun Pal Singh says

    @ishmeetking,
    Usually it does on its own. Calcium supplements are usually not prescribed if you have a good balanced diet.

  19. jacob says

    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?

  20. Dr Arun Pal Singh says

    @jacob,

    You are getting better. It is a good sign. Get an MRI and you would have an objective evidence also.

  21. Gracie says

    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?

  22. Krishna says

    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

  23. Dr Arun Pal Singh says

    @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.

  24. Dr Arun Pal Singh says

    @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.

  25. bailore says

    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

  26. Dr Arun Pal Singh says

    @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.

  27. ishmeetking says

    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

  28. ishmeetking says

    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?

  29. sundaram says

    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.

  30. Bhaskar says

    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

  31. Dr Arun Pal Singh says

    @ishmeetking,

    No! It usually does not comes back to previous shape but if the deformity is not significant, it should not cause much problems.

  32. Dr Arun Pal Singh says

    @ishmeetking,
    I did answer that. Sometimes it gets delayed due to engagements.
    I hope your query was answered well.

  33. Dr Arun Pal Singh says

    @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.

  34. Dr Arun Pal Singh says

    @Bhaskar,
    Talk to your doctor and he would be in better position to explain everything to you.

  35. mary says

    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.

  36. Raghu says

    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.

  37. Dr Arun Pal Singh says

    @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.

  38. kanishk says

    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

  39. s.p. says

    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.

  40. kiran garg says

    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

  41. Dr Arun Pal Singh says

    @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?

  42. Dr Arun Pal Singh says

    @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.

  43. Dr Arun Pal Singh says

    @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.

  44. Dr Arun Pal Singh says

    @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.

  45. Raghu says

    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).

  46. Neenak says

    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.

  47. Dr Arun Pal Singh says

    @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.

  48. jen says

    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

  49. kiran garg says

    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.

  50. Dr Arun Pal Singh says

    @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.

  51. Dr Arun Pal Singh says

    @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.

  52. santosh says

    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.

  53. Dr.Partha Pratim Chowdhury says

    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

  54. Dr Arun Pal Singh says

    @santosh,

    She has been put on antitubercular medication and as per your account is improving. Good luck.

  55. kiran garg says

    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.

  56. Sunil Jain says

    Sir i am suffering from ? pott's spine at T9. some pre & paravertebral fluid.

    I had severe backache since 2 mths. for which was MRI was done diagnosed.

    I have started ATT 4 drugs already 3 weeks. but still have pain which is more even i am on bed rest.

    Analgesics are needed almost daily. (Voveran SR).

    i wan to know from you how much did pain last. or when will i could stop analgesics.

    when repeat mri is needed.

  57. puneet says

    Respcted Sir,

    In 25.04.2010 :-

    It started acute pain in my lower back that even i can not sit or stand.Then after taking pain killers/injections for a week no relief. on the recomendation i took traction for about 15 days ,which give me some relief.then i had done MRI. which gives "There is altered marrow signal intensity seen involving L5-S1 vertible bodies showing patchey hyperintense signal on T2weighted images & hypointense signals on T1 weighted images. There is end plate erosion of the contiguous endplates of L5 & S1vertebral bodies.No definate evidence of discitis seen.No significant pre,paravertebral or extradural soft tisse mass seen. Rest of the vertible bodies shows normal height &MR signal morphology.No significant disc protrusion or extrusion seen.

    IMPRESSION:- Above findings are likely due to alterted marrow signal intensity involving L5 & S1 vertible bodies ? carries spine L5-S1? end plate change.

    Then i have done following tests

    1 Result for Mycobacterium genus—– Negative.

    2. Result for Mycobacterium tuberculosis complex—–Negative

    3.ESR—08mm/hr

    4. All my X-Rays Chest are OK

    Keeping all above i started TB treatment on 24.05.2010 by taking 2Tab of FORECOX daily empty stomak.till now & put belt continously, by that time I can Sit,Stand,walk little…..

    Now after 3 months i can drive, walk,go to my duties,all normal routinewithout any paint except jump,run.. Now i am almost OK except sometime mild pain in back when i though,run or sometimes little paint on right or left back lower mussal.

    Now please suggest me :-

    1. Is my treatment is OK? Do i have Tuberoculoses or not

    2. I am taking FORECOX (Rifampicin 225mg,Isoniazid 150mg pyrazinamide 750mg, Ethamubotol Hydrocloride 400mg) two Tab daily Empty stomek

    3.Should i continue the 2 Tab daily…or reduce to one…..

    4.Suggest what to do now? as i am almost OK aftre taking medicines for about 3.5 months..How long i have to take medicine if treatement OK.

    please guide me because the place where i am posted is too far & no specialist doctor is available here.

  58. puneet says

    Please Ref my 1st Mail 15 Minutes back:-

    I am 38 Years ,Male,

    I am facing one more problem, Sometimes in the evening ( between 6-9PM ) it started some raches on my back or arms or chest ,which looks like long long line or some spots resulting scrach effect. then after few hours it become OK /normal without any medcine . this is since last 3-4 years.

    Is it related with TB?

    or is elergy?????

  59. blessing says

    Hello Sir, my brother is suffering from tb of the spine, but his back is not severly paining him rather his legs are paralyzed, he can't stand talkless of walking. Please sir is there any hope of him walking on his feet again. Please kindly help.

    It really complicated.

    Thanks.

  60. Dr.shonu says

    my father aged about 60yrs diabetic n hypertensive was travelling in a bus, due to bad roads, sudden vertical compression resulted and was suffering from severe low back pain, orthopedician prescribed spasmoproxyvon n chymoral forte tabs for a week, even then the pain is not reduced, so he advised an mri lumbar spine, it showed an impression of minor disc bulge which is age related degeneration, and a bilateral psoas muscle bulky,,,blood reports esr is high wbc highc reactive is high,,,,doctor suspected it as koch's spine advised to start akt 4 n a complete bed rest for 3months,,,,,then akt3,2 and 1,,,,,when i visited to other few ortho ppl they said it can be a local psoas muscle infection,,,i even consulted a neuro physician he prescribed linezolid 600mg tabs,my father started taking those and could feel the difference,,,what would be the probable diagnosis.

  61. rama says

    Sir,

    I am very glad to find this site . I don't know the actual position but My father was infected withbone tb in Dec' 2003 . For one yr. he took medicine and complete bed rest and doctor told to stop the medicine. Now he is walking with the help of walker and he needs assistance in doing his personal works. Plz. tell me what we must do at this situation to make him better. Plz. give your advice very soon.

  62. Shivam says

    Hi Doctor,

    My dad had neck pain around 3 months back. Slowly he developed Cold Abscess in his right hand , which grew in size. Multiple cold abscesses developed on his left hand as well. The same were removed surgically. His blood reports indicated high TLC count and the bacteria Staphylococcus Aureus. He was treated accordingly. However there was pain again and he went for an MRI where 'Tuberculous spondylodiscitis' was diagnosed. We immediately started the treatment using 4 standard TB drugs and Streptomycin injections. It has been two weeks now, he still has pain and some times cannot control his urine / bowels. Please let us know if it is normal. Should he be diagnosed for any other disease ? We are consulting an ortheopedic. My dad has a history of Liver problems some two years back.

  63. Dr Arun Pal Singh says

    @Sunil Jain,

    as the disease process is controlled you would feel better. In some patients symptomatic improvement may take up to 6 weeks.

    If there is no difference by that time, you must talk to your doctor.

    Repeat MRI is generally not needed if patient is improving.

  64. Dr Arun Pal Singh says

    @puneet,

    Are you saying that you are having medications without any consultation with any doctor.

    It is not a good practice and I would suggest you to visit a doctor.

    Your symptoms seem to have improved on antitubercular medications. Therefore there is high probability that you have tuberculosis.

    However, final words could only come from your doctor.

    The duration of the treatment varies with severity of the disease and response to the treatment but in general it is up to 10 months.

    I would strongly suggest you to visit the doctor for proper follow up.

    Good luck.

  65. Dr Arun Pal Singh says

    @blessing,

    Please take him to a doctor, get investigated and diagnosed.

    Only then proper treatment could be begun.

  66. James Chiriyankandat says

    My father is 90 and until falling on his back a couple of months ago was in apparent good health and living independently. He was initially misdiagnosed as just suffering from bruising and muscle strain. However, after several weeks in which he didn't show any sustained improvement (though he did walk a bit and even climb the stairs slowly on one occasion!), he was hospitalised after falling again in pain. He was then diagnosed as suffering from bone TB that had led to the virtual destruction of his 10th and 11th vertabrae. He is now back at home bedridden and on a nine month course of oral treatment. What are the chances that he will be able to move about again, even with a walker? Is surgery (vertebroplasty or kyphoplasty?) out of the question at his age? Is bone TB infectious?

  67. Dev says

    Dear Doctor, I have been diagnosed Spine TB D 9-10 left hand side in May since then i am on medicine and bed rest, last week my doctor has stopped Pyrazinamide and Coimbutol but R Cinex, Benadon and Triozac are in continuation, i have been on rest since May sometimes i am getting a pain in tail bone area and also please advice when should i resume back to work. I can email you my MRI reports also.

    Many Thanks

  68. Dr Arun Pal Singh says

    @Dr.shonu,

    As you would understand I am not the right person on giving an opinion on diagnosis as I cannot examine the patient physically.

  69. Aakshata says

    Dear Doctor,

    My husband was diagnosed with Spinal TB on 30th Aug 10 after battling chronic back pain and muscle spasm for 4 months. His gait got wobbly that is when we suspected it could be serious. He was admitted to Hinduja Hospital where a CT guided biopsy was done to confirm TB and he was started on ATT treatment. His progress was very slow and got discharged on 16th Sept 10. He continued to experience numbness in the abdomen area and his limbs were also a bit weak. On 24th Sept 10 he became wobbly again with his left feet getting heavy. So we have admitted once more in the hospital. The doctors advise surgery as the nerve compression has not subsided ; a repeat MRI was done to confirm the same. damage has occured to D2 and D3 . Needed a second opinion on whether surgery is mandatory as we are still skeptical of him going under the knife. Pls advise.

    Thanks

    Liji

  70. Dr Arun Pal Singh says

    @rama,

    You need to provide me more information. There is not much that I can deduce from what you have provided me with.

  71. Dr Arun Pal Singh says

    @Shivam,
    A poor control of bladder/bowel indicates that there is compression in the spine. You did not mention the level of spondylodiscitis.

    What did MRI suggest about neural compression?
    Is he on bed rest/traction?

    I see that it has been two weeks since you posted. How is his condition now?

  72. Dr Arun Pal Singh says

    @Dev,

    Have you improved on treatment?

    You can mail me your reports using address on "contact us" page

  73. dev says

    Thanks Doctor for replying, yes Doctor there is an improvement now i am able to sit and walk slowly at times i am getting pain in tail bone area when i usually sit for long hours , how long it will take me to resume job, i am arranging a cd of mri report i will email you shortly.

    Thanks a lot

  74. Dr Arun Pal Singh says

    @Aakshata,

    I cannot give you a second opinion as I cannot examine the patient.

    But I would explain you the treatment protocol.

    In tuberculosis of spine there are many schools of thought from totally conservative to totally operative.

    What most doctors follow are middle path regime in which the initial treatment consists of medication and rest including complete bed rest if there is a neural deficit.

    However, if the patient does not improve or worsens on the conservative treatment, he requires surgery.

    There are many ifs and buts associated but it grossly covers everything.

    If you really wish to have a second opinion you need to see somebody in person.

    I hope that helps

  75. Prateek says

    To: doctor

    my father was diagnosed with potts spine 2 months back. the doctor initially asked us to start with CAVATIER-4FD but the kit didnt suit him and he gained jaundice out of it.so the medicines were stopped imediately and the pain went upto extreme levels. so he was operated and the pus was removed and asked to start all the medinces. but he again acquired jaundice so the medicines like rcin,INH,pzamide were stopped, but medicine like Septomycine,microbutol,oflox was being continued. he was called for re-examination after 6 weeks post discharge with the latest MRI scan done. when the doctors had a look at the reports of the scan they say that the pus has increased further despite of it being removed.so they want to operate him again but before that he is advised to start main coarse medicine like rcin, inh,etc.

    Now r-cin,INH are not causing any problem. Pzamide had beed started.

    How much time it will take to be cured.Does he need to go for surgury again with rods.

    Please advise.

  76. Faith says

    Hi DR i was diagnose with tb spine on the 21 of june and admitted for two weeks i started the treatment but i still got this heavy pains on my ribbs, hip and my back. doctor is to early to complain because i thought by this time the pains were going to be much better but some of the bones are collapsed on my spine am i taking the medication correctly because my weight is 75

    Many Thanks

  77. Faith says

    Dr i am still taking the treatment and i got the belt but when i put this belt the pains be come more worse do i have to put it for the whole day or some few hrs

    Thanks

  78. Dr.sanjiv k bhalla says

    i am dr.bhallafrom farid kot, i hav bee nn diagnosed tb spine of d7-8 on 25 september 2010

    and confirmed by ct guided fnac,No neurological symtoms are there so far

    taking rcenex600,ethambitol 1200,pyzina 1500 and isonex300 and other vitamin and calcium suplements from 25-09-10

    from very day of biopsy i have been feeling burning type of sensation just below left costal margin

    this sensation developed immediately after rather at the time of fnac done.

    confusing part is of rest to what extent i need it

    i am donig 18 hrs rest in lying, 3-4 hours are spent on doing ultrasounds that too without bending.

    please advise me more about bed rest

    can i talk to u on phone

  79. Dr.sanjiv k bhalla says

    Hello Dr Arun pal jee,

    Nice talking with u on phone.
    U R REALLY DOING A GOOD JOB BY GUIDING PEOPLE ON NET.
    I really feel relaxed after talking to u.
    Now i am feeling that I will be alright without any complications.
    Thanku soo much 4 the all.

    DR.SANJIV K BHALLA

  80. Dr Arun Pal Singh says

    @jimmy lee,

    Per se TB spine is paucibacterial disease. For that matter all osteoarticular tuberculosis is.

    That means the density of bacteriae is very little. SO pure TB spine is not a threat to others.

    But if it associated with concomitant TB of lungs, then spread of TB may occur from the lungs.

  81. Dr Arun Pal Singh says

    @Prateek,

    The doctor who sees him personally is in best position to suggest if he needs surgery and of what kind.

    Time taken to cure would depend on the severity of the disease and response to the treatment.

    Again your doctor is best person to talk about it.

    But in general if TB spine occurs with neurological deficit, the period of return to normalcy may vary from 6 months to one year, if everything goes well.

  82. Dr Arun Pal Singh says

    @Faith,

    You need to be precise with your information and query. I cannot find any question if you intended to ask one.

  83. Dr Arun Pal Singh says

    @Dr.sanjiv k bhalla,

    There might be a damage to nerve while FNAC. It should get better with time.

    Your response to the treatment would guide the period of rest.

    You would be able to gauge for yourself.

  84. debbie mack says

    Hello, Iam concerned that I have been diagnosed with an OS odontoideum and have been told that surgery is contraversial and was told to practically live in a neck collar instead. I dont want unneeded surgery,but I dont want to be in pain the rest of my life, and dependent on a collar.I am just wondering at what point do you say its time to do surgery? I am frustrated andsaddend that at 48 yrs old,I have many years left to have to tolerate this.Any suggestions?

    Thank you!

    Debbie Mack

  85. Dr.sanjiv k bhalla says

    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

  86. Dr Arun Pal Singh says

    @Dr.sanjiv k bhalla,

    There is reduction of the inflammation and quantum of infection appears to be reducing.

    All the best.

  87. Happy says

    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?

  88. Dr Arun Pal Singh says

    @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?

  89. shanthi says

    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.

  90. Jayed Bin Jasim says

    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…

  91. Dr Arun Pal Singh says

    @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.

  92. Dr Arun Pal Singh says

    @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.

  93. Rohit Bahl says

    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

  94. kavin says

    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

  95. Dr Arun Pal Singh says

    @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?

  96. Rohit Bahl says

    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

  97. DR.SANJIV BHALLA says

    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?

  98. Padma Ram says

    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

  99. Dr Arun Pal Singh says

    @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.

  100. Dr Arun Pal Singh says

    @kavin,

    Minor symptoms often occur during the course of healing. If the symptoms are persisting, get evaluated by your treating doctor.

  101. Dr Arun Pal Singh says

    @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.

  102. Sangeetha says

    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?

  103. Dr Arun Pal Singh says

    @Padma Ram,

    Physiotherapy is needed to strengthen your musculature.
    Please follow your doctor's advice in regard to physiotherapy.

  104. Dr Arun Pal Singh says

    @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.

  105. James Chiriyankandat says

    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.

  106. Pachu says

    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

  107. prashanth says

    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

  108. Bass says

    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.

  109. Bass says

    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.

  110. Sanganika says

    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

  111. Dr Arun Pal Singh says

    @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.

  112. Dr Arun Pal Singh says

    @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.

  113. suneetha vaka says

    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

  114. jeny says

    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

  115. Dr Arun Pal Singh says

    @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.

  116. Dr Arun Pal Singh says

    @prashanth,

    That is not included in standard regimes. Please speak to your doctor.

  117. Dr Arun Pal Singh says

    @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?

  118. Dr Arun Pal Singh says

    @Sanganika,

    If he has tuberculosis, he should be put on complete bed rest and antitubercular chemotherapy.

    How is he now?

  119. Sanganika says

    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?

  120. Dr Arun Pal Singh says

    @suneetha vaka,

    Please see a spine specialist who would invesitigate as required.

  121. Dr Arun Pal Singh says

    @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.

  122. Bass says

    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.

  123. shankar says

    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.

  124. anitha says

    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.

  125. Manish Dev Vishwakar says

    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

  126. Bass says

    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.

  127. Vijay Jain says

    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?

  128. waylin says

    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

  129. Abhijeet says

    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 ?

  130. Dr Arun Pal Singh says

    @Sanganika,

    Antitubercular chemotherapy consists of injections and oral drugs. I think he is being treated on right line.

    How is he now?

  131. Dr Arun Pal Singh says

    @shankar,

    She would be on bed rest for long time. Did she undergo surgery?

  132. Dr Arun Pal Singh says

    @anitha,

    recurrence or recrudescence is known. Please get in consultation with doctor to get investigated.

  133. Dr Arun Pal Singh says

    @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?

  134. Dr Arun Pal Singh says

    @Bass,

    Abcess means infection and since you had an overseas travel, tuberculosis appears a possibility.

    Consult your specialist.

  135. Dr Arun Pal Singh says

    @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.

  136. Dr Arun Pal Singh says

    @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.

  137. Dr Arun Pal Singh says

    @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.

  138. Bass says

    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.

  139. kumar sunny says

    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?

  140. Rohit Bahl says

    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

  141. Dr Arun Pal Singh says

    @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.

  142. Dr Arun Pal Singh says

    @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.

  143. Dr Arun Pal Singh says

    @kumar sunny,

    Why she is on second line of drugs?

    Is there any resistance to medication?

    What does her treating doctor tell you.

  144. vivek chawla says

    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)

  145. Radhika Kalra Choudh says

    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?

  146. Sunil Jain says

    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 ?

  147. Gene Johnson says

    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

  148. Dr Arun Pal Singh says

    @vivek chawla,

    The treatment is available across DOTS centers free of cost. For other things the treating doctor would have better and specific answers.

  149. Dr Arun Pal Singh says

    @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.

  150. Rohit Bahl says

    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

  151. Dr Arun Pal Singh says

    @Sunil Jain,

    Things would get better with passing time. Talk to your doctor- You should be on two drugs by now.

  152. Dr Arun Pal Singh says

    @Rohit Bahl,

    An increase in spasticity probably means increase in compression and cause should be looked for.

  153. Bass says

    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.

  154. Bass says

    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.

  155. Bass says

    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?

  156. rohini says

    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?

  157. Harcharan singh says

    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

  158. akansha gupta says

    Hello! DR.

    is spine t.b communicable? if yes to which extent? what precautions to take?

    please reply.

  159. Dr Arun Pal Singh says

    @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?

  160. Dr Arun Pal Singh says

    @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?

  161. bass says

    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?

  162. fatimaa khan says

    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.

  163. Bass says

    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.

  164. Dr Arun Pal Singh says

    @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.

  165. Dr Arun Pal Singh says

    @Harcharan singh,

    It is very difficult to speculate. Hope for the best and carry on with your treatment.

  166. Dr Arun Pal Singh says

    @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.

  167. Dr Arun Pal Singh says

    @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?

  168. Dr Arun Pal Singh says

    @fatimaa khan,

    It means there is some kind of compression on the nerve.

    Did you talk to your doctor?

  169. chipo mufudza says

    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

  170. Dr Arun Pal Singh says

    @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

  171. Bass says

    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.

  172. DEB SARKAR says

    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

  173. K Chakrabarty says

    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

  174. Dr Arun Pal Singh says

    @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?

  175. Dr Arun Pal Singh says

    @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.

  176. Dr Arun Pal Singh says

    @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.

  177. Bass says

    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.

  178. K Chakrabarty says

    Dear Doctor,

    Thanks for your reply but the second paragraph does not seem to be complete, can you please finish your sentence?

    Regards,

    KC

  179. K Chakrabarty says

    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

  180. Dr Arun Pal Singh says

    @K Chakrabarty,

    It is complete. The sentence had jumped up, so I have corrected that.

  181. DEB SARKAR says

    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

  182. aj tato says

    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

  183. SUMI says

    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

  184. Ameer says

    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

  185. Riya says

    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

  186. Jatin says

    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?

  187. Rahul Arya says

    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…

  188. suleka says

    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

  189. usha says

    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.

  190. Dr Arun Pal Singh says

    @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.

  191. Dr Arun Pal Singh says

    @K Chakrabarty,

    Gastritis is a common effect of these drugs. What does MRI say?

  192. Dr Arun Pal Singh says

    @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.

  193. Bass says

    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.

  194. Dr Arun Pal Singh says

    @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?

  195. Dr Arun Pal Singh says

    @SUMI,

    Please avoid all CAPITALS

    Do you have any symptom right now or you are just being apprehensive.

  196. Dr Arun Pal Singh says

    @Ameer,

    You need to provide more details please. Did he suffer any injury in the ribs.

  197. Dr Arun Pal Singh says

    @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.

  198. Dr Arun Pal Singh says

    @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

  199. Dr Arun Pal Singh says

    @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.

  200. Dr Arun Pal Singh says

    @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.

  201. Riya says

    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

  202. Chanti says

    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.

  203. Nora says

    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.

  204. Dr Arun Pal Singh says

    @Riya,

    Please ask your treating doctor about your doubts. He is in a better position to answer your questions.

  205. Dr Arun Pal Singh says

    @Bass,

    Clindamycin is effective in range of bacteriae. Has therapy worked [Though blind] ?

    How are things?

  206. Bass says

    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.

  207. Bass says

    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.

  208. Dr Arun Pal Singh says

    @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.

  209. keshao says

    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.

  210. Dr Arun Pal Singh says

    @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.

  211. jatin says

    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?

  212. jitendra kumar says

    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

  213. Gandhi Yandapalli says

    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..?

  214. Dr Arun Pal Singh says

    @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.

  215. ANKIT GUPTA says

    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..

  216. wale says

    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.

  217. muhammed says

    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)

  218. yp sharma says

    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

  219. Dr Arun Pal Singh says

    @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.

  220. Dr Arun Pal Singh says

    @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.

  221. Dr Arun Pal Singh says

    @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.

  222. Dr Arun Pal Singh says

    @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.

  223. Dr Arun Pal Singh says

    @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.

  224. Dr Arun Pal Singh says

    @ 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.

  225. priya ranjan samal says

    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.

  226. ankit says

    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..

  227. sandy says

    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 .

  228. sandy says

    Sorry, on my earlier post. I meant to say can latent tb come back with the onset of pneumonia .

  229. Dr Arun Pal Singh says

    @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.

  230. Dr Arun Pal Singh says

    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.

  231. Dr Arun Pal Singh says

    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

  232. Dr Arun Pal Singh says

    @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

  233. Riya says

    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

  234. asha says

    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

  235. Dr Arun Pal Singh says

    @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.

  236. Dr Arun Pal Singh says

    @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.

  237. Ankit gupta says

    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.

  238. sushil says

    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

  239. KUNDAR says

    Dear Doctor

    My son was suffered for Hydrocdepholous. As per advice of doctor surgery was done and shunt at left side has been installed. After surgery he was ok. After one month one he fell down while playing. After two days one morning noticed that he could not raise from the bed and could not move his right leg and right hand. We immediately consulted doctor. doctor advised another surgery, accordingly surgery carriedout. After physiotherapy and other exercise he walked and now he is ok. but probelm is that he could not run and stand properly and walk properly. While walking bending his body and his right leg and hand week means not strong as normal boy. His waist is not strong.

    Please advise what exercise to be done to make his waist,right leg and right hand make strong and

    any other treatment is required. Now his age is 15 years.

  240. dahlia says

    my mom 63 was diagnosed with tb of the spine and was put on eight months medication of which she completed. she got better and started walking again though the walking is not so perfect. my concern is to know whether she will fully recover and walk properly again. my mom also had a problem in speech but after medication she is able to speak. does it mean that her memory was affected due to tb? Dr what should we do as a family to help her through her problems. what happens now is that sometimes when she coughs urine pass and also she feels pain in her legs sometime, is it normal.

  241. sagar bhargav says

    Hi, I had pain. From 4 months in my back. Now did mri, and montax test, doc said it is spine TB, affecting L5. Now started with 4D anti TB drugs. How long I should tAke bed rest, Esr is 61 and CRP s 38.

    Regards,

    Sagar

  242. Riya says

    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 ,and she has completed 9 months taking AKT3 Dr has advised her for excercises which she does regularly but her back is still stiff and sometimes she feels pain in lower limbs.my queries to you are:

    1. how much more time she will take to recover fully

    2.how we will know her abscess is getting dried

    3.how we shall be confirmed that she is not drug resistant

    4 will she able to perform her routine work like earlier

  243. Dr Arun Pal Singh says

    @sagar bhargav,

    What is your doctor's advice regarding rest. The period of rest would depend on severity of the condition and presence of neurological loss.

    Please follow your doctor's advice.

    There are different protocol of duration of treatment varying from 9 months to 1.5 years. Again, your response to treament would guide the duration.

  244. Joane goh says

    I am a 64 years old female. At age 1, I had Potts' disease. I believed I was treated for it. I eventually got well, learnt to walk when I was 6 years old. Through the years I have some pain in my neck and spine but manageable. About 6 years ago, I was told I has arithritis in my neck. I am getting some pain down my left arm and numbness and tingling sensations in my last 3 fingers. My MRI shows old injury to T2, T3 and T4. In fact, T2 & T3 are fused together, due to the damage caused by Pott's . My question is how do I stabilise my spine, or can I correct my curvature, and do I need to test for resurgence of Pott's.

  245. Sagar says

    Thanks Dr. Arun Pal

    My doctor adviced me 6 weeks of bed rest, it means I need to sleep for most of the time, now I have completed 20 days of treatment. No fever now. I knew it is chronic, treatment would last more than 6 months, but how long should I take bed rest and when I press my right leg I get slight pain above my hip. Will I regain my strength and able to play cricket(my fav sport) or atleast normal life, am an engineer I should always keep sitting and working with computers..

    Regards,

    Sagar Bhargav

  246. Dr Arun Pal Singh says

    @Sagar,

    Give it the time it demands and follow your doctors advice sincerely. Most of patients recover uneventfully.

    All the best.

  247. Dr Arun Pal Singh says

    @KUNDAR,

    I think the cause lies in the brain and there is a residual weakness in the affected parts.

    Youshould consult a neurosurgeon on this issue. It does not seem like orthopedic problem.

  248. Lord Angelo says

    Hello Dr. Arun Pal Singh

    Hi, I had diagnosed with tb spine in my back with T10 and T11 in thoracic and now i take medicine for almost 9 months already. Doc can i ask if the kyphosis in my back can be correct with proper treatment??

  249. shazia says

    i am suffering from spine tb.is it necessary to have bedrest??does the pain comes back if we are not taking rest..?

  250. John says

    Hello, I was diagnosed with spine TB 10 years ago i did finish my medication however, I didn't do any surgery. I have a deformity on my spine. I usually have pain on my lower spine. Is there a way where I can rid off the pain that I have and is there a way to restructure my deformed spine,

  251. Dr Arun Pal Singh says

    @shazia,

    Rest is important part of the tretemnt. If it has been suggested to you, you should follow the advice.

  252. Dr Arun Pal Singh says

    @John,

    Residual pain is a problem especially when ther e is a deformity.
    .
    Medication and exercises for spine are the usual line of treatment for mild and moderate severity

  253. Dr Arun Pal Singh says

    @Lord Angelo,

    The deformity would not correct with medication and rest. Only way to correct is surgery and that is not recommended in every case.

  254. RAJASHEKAR says

    hi doc ,

    i have been infected with tb on my cervical neck bone on c2 and the bone got melted ….so doctors fixed a hallow brace for about 6months later they removed and went for surgery and they fixed a steel plate with screws between c1-c3 ….now i am unable to rotate my head left and right and up….so can u please suggest is there any other process for rotating my head or is there any bone growth occurs …???

  255. Dr Arun Pal Singh says

    @dahlia,

    I apologize for this substantial delay. How is your Mom now. Would you please let me know the current situation.

  256. Dr Arun Pal Singh says

    @Riya,

    I am sorry for the delay in replying. WOuld you please let me know the latest on your mother's condition.

  257. Dr Arun Pal Singh says

    @Joane goh,

    You need to consult a physician in person to answer your doubts. Have you done that?

    Mild residual pains can occur after spinal deformities but if the symptoms are severe and persist, tests are warranted to rule out resurgence.

  258. Ramesh Kumar says

    Hello Sir,

    I was diagonsed with TB in the year 2005 and under antituberculous medication for Seven Months. I was a smoker and smoked during the medication. Not checked whether TB has been completely cured and eliminated or not. From 2006 i started sciatica like pain first and after that gradually back pain, arms and neck pain, pain in only right side of the face like right jaw, right ear etc… Recently in 2012 i did a MRI and it shows

    Impression

    No Evidence of discitis or osteomyuelitis changes

    Bulging annulus seen at L4-L5 L5-S1 levels narrowing the spinal canal and slightly indenting the spinal canal.

    Hip/SI Joints

    No obvious demonstrable pathology in SI joints and Hip joints

    Whole Spine

    Broad based disc protrusion seen at C5-C6 C6-C7 Levels narrowing the spinal canal and slightly indenting the cord surface.

    Is this due to spinal tuberculosis. And if i undergo Antituberculosis Chemotherapy again (First one in 2005) will it be successful.

    Please help me if it is Spinal Tuberculosis or else. I am afraid of MDR-TB

    Please help.

  259. Ramesh Kumar says

    Hello Sir,

    I was diagonsed with TB in the year 2005 and under antituberculous medication for Seven Months. I was a smoker and smoked during the medication. Not checked whether TB has been completely cured and eliminated or not. From 2006 i started sciatica like pain in right leg first and after that gradually back pain, arms and neck pain, pain in only right side of the face like right jaw, right ear etc… Also it looks like, I am having hair loss in my right side scalp more than my left side scalp. Recently in 2012 i did a MRI and it shows

    Impression

    No Evidence of discitis or osteomyuelitis changes

    Bulging annulus seen at L4-L5 L5-S1 levels narrowing the spinal canal and slightly indenting the spinal canal.

    Hip/SI Joints

    No obvious demonstrable pathology in SI joints and Hip joints

    Whole Spine

    Broad based disc protrusion seen at C5-C6 C6-C7 Levels narrowing the spinal canal and slightly indenting the cord surface.

    Is this due to spinal tuberculosis. And if i undergo Antituberculosis Chemotherapy again (First one in 2005) will it be successful.

    Please help me if it is Spinal Tuberculosis or else. I am afraid of MDR-TB

    Please help.

  260. Ramesh Kumar says

    Sorry Sir,

    One more additional information. When i was diagnosed TB in 2005, i had a lump in the left side of my neck for more than 2 or 3 months I think. It was just above the collar bone and it cured after the puss got removed from it.

    Ramesh Kumar

  261. Sagar says

    Hello Sir,

    After 2 months of medication and rest, I had MRI as follow up. It states

    1. Altered signals and thin para vertebral tissue found near L5 to S1-S2 level with Cortical irregularity.

    2. Disc desiccation at L5-S1 level.

    NOTE: Compared to previous MRI done on Jan -14th-2012 there is "Significant reduction in signals and size of the para vertebral tissue".

    I feel better now and started to go to work. Can you please tell regarding this MRI report, is there any improvement.?

    And please explain regarding the "Disc desiccation" and Cortical irregularity.

    ESR is reduced from 61 to 22 after 2 months.

    My doctor is on leave for 2 weeks, so plz help me regarding this.

    Waiting for your reply….!

    Regards,

    Sagar

  262. Rosemary Palmer iyi says

    Dear Doc,

    I'm very pleased to with d way u treat treat people's articles with so much respect and passion,more grease to your elbows sir. I was diagnosed with TB of d spine a year n some months ago affecting t6. All the test I did came out well so I was placed on anti TB drugs like Rifampicin,isoniazide,pyrazunamide,ethambutol and pyridoxine for 9months.on the first 3months pyraazunamide n ethambutol was taken out left with d other three of which I'm currently on now but still feel severe back pain n neck pain which I got as a result of a bike accident. Doc my question is can I get another medication apart from these drugs cos I get relief 4 some time and later it starts again.n secondly can d drug still work if after u miss a days Tablet.or should I just start all over again 4 another 9months. I'av apetite n I feel fine most of the time weight loss is as a result of severe pain at my Back.is massaging good 4 TB spine I usually get a relief when I get a massage.thanx so much I will be glad if my post is treated.

  263. riya says

    Dear Sir,

    Doctor has started with AK2 from last 15 days and physiotherapy but from last week she is feeling mild pain in legs and back stiffness is as it is and feel exhausted,sir i am very much worried why its happening and will she fully recover and how much approximately time she will take?Please reply me soon sir.

    Thanking You

    With Regards

    Riya

  264. Dilip Sinha says

    Dear Doctor,

    As I have read my Cases of TB in Spine. I also have the same deases suffering from April-2011 and taking ATT since 15 may-2011

    AKT-4 For 4 MONTH Regularly.Local doctor have chnage the medition R-CINEX-600,p-zide-750(morning and evening),benadane.

    Three time PUS have been removed from my D9-D8 area.But after 10 month of continuous ATT. still PUS IS Coming.I reconsult the doctor he told me that M edition will be continue

    I am worry about when this desese will be end from my body.

    Doctor pl advise.there are many test have been done like TB culture,Biopy ESR all report are -ve..

  265. Sarla says

    Hello Doctor Sir,

    I am 23 years old working girl.I am suffering from Bone TB in my right thigh.I got surgery of my thigh on 24Jan2012. After 1 month of surgery when the drainage pipe was taken out I am feeling joint pain in my ankle,wrist, hip joint.I am taking my medicins daily. The doctor said that the pain is due to weakness and lack of protein.I don't know why is it happening? Pls advice me.

    Regards

    Sarla

  266. Giovanny says

    Dear docter, my mum is under treatment of tuberculosis l3l4 about 4 month , now she suffer of an apcesse on the right hand leg and she can't straight it, she also suffer of urine infection thanks for your reapply

  267. Dr Arun Pal Singh says

    @RAJASHEKAR,

    Fusion between C1-C3 would result in loss of rotation but there is no process to bring it back, once fused.

  268. Dr Arun Pal Singh says

    @Ramesh Kumar,

    As per your reports it it is not TB. Please see a doctor and get treated for what you have.

  269. Dr Arun Pal Singh says

    @Sagar,

    Yes! There is a definite improvement. Disc dessication and cortical irregularity are due to the disease and may be a feature for some time.

  270. Dr Arun Pal Singh says

    @Rosemary Palmer iyi,

    It is not advisable to miss the antiTB medication. If you miss it for some period continuously, you might be needed to put on medication again ffrom the start.

    You can take painkillers as and when they may be required after consultation and prescription of your doctor.

  271. Dr Arun Pal Singh says

    @riya,

    Only time would tell what would happen in a particular case. But yes! Most of patients do recover within 4-6 months of time. Some take even longer.

  272. Dr Arun Pal Singh says

    @Dilip Sinha,

    You may like to undergo test for culture and sensitivity of the pus to check for resistance to any of the drugs being given.

  273. Dr Arun Pal Singh says

    @Giovanny,

    Would you please elaborate so that I could answer the question in better way.

  274. mansi sharma says

    i am 23 yr old.i have transverse myelitis.due to this my leg paralysed since last year.but at this time i am walking with walker and good movement.i have loss of sensatation problem yet on my right leg.bowel and bladder problem also due transverse myelitis disease.urine incontinence and leakage problem.plz. Suggest me.

  275. dr pamit tiwary says

    dear dr,

    My brother was diagnosed with pott's spine last year in june.initially,he was kept on conservative rx ( bed rest + ATT) for 4 months but he developed neurological deficit (grade 0 power) in lower limbs and underwent decompression surgery with fixation (D9-D10).although sensations and bladder functions are intact, spasms are still very much predominant (despite administration of baclofen 30mg/day).Its been 6 months post surgery but he has no relief from spasms which hinder in his physiotherapy.what should be done or should we wait for more recovery,Post op MRI and CT show no evidence of abscess or compression.

  276. Ramesh Kumar says

    hello Doctor,

    I can't see my comments and the answers here. can you please help

    Ramesh Kumar

  277. Bass says

    Hello Dr. Signh

    I havent posted here in a while and thought Id update and ask a question. My none TB spinal infection is scattered in 3 areas of the spine. Mid t spine about 3 or 4 vertebraes, one in mid lumbar and in lumbar facet joints. The bacteria has ridden my entire spine after my UTI but was soft tissue only, then seeped into bones and joints. Many areas were erradicated but whats left now are stubborn areas and what worried me most is the mid T spine ones.

    Questions

    Is it normal for bacteria to ride the soft tissue on the front of the spine all the way up. The first disc that started this was the one next to the infected kidney, then went down and all the way up and stopped. I felt severe tingeling and followed it move. But is this possible for bacteria to ride soft tissue on the outside of the spine?

    what happens in the event 4 bones need replacement, is there such surgery? TO replace bones and discs?

    My last drug I tried was meropenem, and in 10 days I felt as if there was nothing wrong after suffering for months, so this is 100% infectious. Unfortunately each drug I use, stops working a short period after. I believe the reason being is the lack of information physicians have on treating none TB spinal infection, there is no protocol. My physicians were using 1 ABX at a time, when if you look at the TB model, they use 4. I know exactly why they use 4 now, to avoid whats happening to me.

    The suspected pathogen is an Anaerobe, and Flagyl was a wonder drug for exactly 3 days, then stopped working very fast but was very potent. Iam suffering a great deal.

    As a last resort I might try Theomphenicol, but I would need high enough doses to penetrate the bone and keep adequate levels of the drug in the bone.

    Clyndamycin also worked but then stopped.

    Iam running out of options, would you know what else might respond to an Anaerobe. Unasyn didnt do anything to whatever I have.

    so

    Can 4 bones be replaced if so whats this procedure called? If not then what do you do if there a stubborn infection in 4 bones?

    Have you ever used Themophenicol usually given for Typhoid fever, to treat bone infections and would you be against it knowing the risks of Aplastic Anemia?

    Can an infection ride the soft tissue part of the spine from mid spine to all the way up and down to the lower Lumbar?

    Good to see you active on this forum and helping everyone. God Bless you.

    Bass

  278. Bass says

    Little more about me Doc, Iam currently on Cefazolin 12gm a day, and once again was working great but now weaker and weaker, I can flex my spine a lot better but the bones wont cure. So Im guessing its penetrating soft bones but not hard bones.

    The bacteria I have learns to create resistance rapidly, not sure if this is a normal behavior of all bacteria or just my type. I also noticed if a drug works well in 10 days I can feel as if nothing happened.

    After the infection rode my spine, once it reached my mid T spine it penetrated thru a disc and now its right the inside of the spine, and was told if I need cleaning they would have to go thru my lungs/ribs. Very scary situation.

    I wish we had cultures it would probably save my life, however Iam positive this bacteria would have suseptible to many ABX at first, so what good do cultures do in the begining. I feel now would be a great assesment of the bacterias sensitivity, but again the area to biosy is on the back of the spine. The lumbar are of pain, is on the front of the spine and might be able to get a biopsy.

    I also noticed some drugs such as invanz which didnt do anything ( but meropenem did) makes other ABX not work. SO invanz and Bactrm will not work but bactrim alone will work.

    One drug thats left I havent tried yet is Tygacil, which Im not having high hopes for. Currently my team in NY are searching for infectious disease bone specialists. Who understand bacteria more then them.

    I have learned how this bacteria behaves to much, the 3 locations of the infection all respond to the Antibiotic when it works, and all 3 become severely painful when I stop.

    I dont think I will make it out of this, but Iam fighting.

    I also noticed if I stop an ABX for a while due to not working, it can work again after stopping for several months. Just amazing but then stops again.

    I also tried hyperbarric Oxygen therapy, which helped but nothing worth the expense and hassle.

    I also noticed if I eat high sugar drinks, Iam in much more severe pain, this happened several times and I feel this bacteria thrives on sugar.

    How do you stop bacterial resistance?

    if its an Anaerobe, my options are limited to cefalasporins, clynda, Flagyl, Theomphenicol. Only the cephalasporing are beta lactam ABX, does that mean its much easier for the bacteria to create resistance with Clynda an Flagyl?

    Any other way to kll Bacteria in bone, I read about ABX beads but will be impossible to implant. Any other technology out there? Lasers, Radio Frequencies.

    I would never rely on ABX alone to treat infections, and never prescribe one drug at a time. TB protocol of 4 drugs is for a good reason.

    Thanks for your time

  279. Riya says

    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 ,AKT3 and now on AKT2 and she has completed one year of treatment Dr has advised her for excercises which she does regularly but her back is still stiff and sometimes she feels pain in lower limbs.my queries to you are:

    1. how much more time she will take to recover fully

    2.how we will know her abscess is getting dried

    3.will she able to perform her routine work like earlier

    Please Sir do replly my queries

    Thanking you

    With Regards

    Ms Riya

  280. ginger says

    I started feeling slightly ill 7-8 months ago, been pretty healthy up till then. Every week or two would get increased symptoms. I quit work, got severely dry sinuses, some bleeding, then lungs felt bad and larnyx. Now I am experiencing spine pain, weak and burning muscles, back of neck and hard to hold my head up. If I have tb I am suspecting that it began in ny sinuses. They still feel very abnormal and dry, a dental xray showed extreme cloudiness in sinuses. Where can I get checked for sinus tb and skeletal tb/muscle tb? I just keep gettibg worse. I am 50. thanks

  281. Dr Arun Pal Singh says

    @dr pamit tiwary,

    After decompression we need to wait for natural recovery. Spasms persist for quite a long time.
    though.

    How is he now?

  282. Dr Arun Pal Singh says

    @Bass,

    Sorry for the unwanted delay. I sincerely hope you are better now than you have described above.

    No! You do not replace 4 vertebrae. Most of the cases of infections are controlled by antibiotics and usally heal with or without residual limitations.

    One of the natural consequence of the vertebral infection is fusion of the vertebrae.

    Response to antibiotic does indicate infectious nature but only culture and sensitivity or histopathology can confirm.

    If it is an infection the treatment has to be guided by the sensitivity rather than blindly trying for options.

    Thiamphenicol [I think you have a typo there] unlike chloramphenicol is not associated with aplastic anemia. [Source Wikipedia]

  283. Dr Arun Pal Singh says

    @Bass,

    TB is a special case. Most of the drugs for bacterial infections are not given in group of 4 or so.

    One of the other things I would suggest is to find if something is wrong with your immune system.

    If your defences are working right or not.

    How are you now?

  284. shadab says

    hello sir i am 30 year boy,i was diagnosed wid pott spine at L3,L4 in 20/dec/2011. and start akt4 now i take akt3 my esr::6 and crp:::: .6 ultrasound says there is not any puss collection, but still i have alot of pain in my both legs.

  285. Dr Arun Pal Singh says

    @Riya,

    Your 1st and last query cannot be answered as the period varies and as such cannot be predicted.

    For your second question – There would be clinical improvement and the imaging would show reduction in size of the abscess.

  286. Dr Arun Pal Singh says

    @ginger,

    Please seek an opinion from a medical practitioner in your vicinity and follow his advice.

  287. Riya says

    Dear Sir,

    Thank you for your reply but please tell me that my mother always have pain in back and bones and she does not feel relax ,she is now on AKT 2 and she has completed one year of treatment.her X-rays shows improvement but then why she feels pain overall.

    Please do reply me.

    Thanking you.

    with regards

    Riya

  288. rashid says

    sir my both hand infected tb infection i am taking daily madician but i am not seeing any result plz guide me

  289. rashid minhaj says

    sir my my bone tb infection treatment start from 6 january

    and medition (rifampicin u.s.p 150,isoniazid(=inh)b.p 75 mg, parazinamide b.p 400 mg, ethambutol hcl u.s.p 275 mg. i took this medician for 3 month 3 tablets daily before break fast. after this doctor i got my surgery of right hand joint and after drainage .i am looking multiple hole place in back side of ulnar tuberosity and bleeding there hole and abses coming like a drops slowly . and some time i feel pain and i cant move my hand completely i have to support anuther hand to move my hand. after surgery i am taking this medician (rifampcin 150mg ,isoniazid 75mg, ethambutol hcl u.s.p 275) 4 tablets daily taking yet . i worry sir please am in home from 8 month please give me your email .i wanna talk with you.please my doctor said u will have to take medician 18 month. and when i fell little pain in left hand medial epicondyle after doing xray doctor said tb spot also there and antibiotic start again (ciprofloxacin 500 mg two tablets daily i am taking from 1 month and also tuberculosis medician.

  290. Rose says

    Ian 24 yrs old presently on att,iam taking rifampicin, isoniazid, ethambutol, levofloxacin. Ten days back pyrazinamide was withdrawn by my doctor after I started complaining of severe pain in my joints associated with swelling of the affected joints, but I still continue to have the same problem. Please kindly share your opinion.thank you

  291. Riya says

    To,

    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 ,AKT3 ,AKT2 and she has completed oneand half years of treatment Dr has advised her for excercises which she does regularly but her back is still stiff and sometimes she feels pain in lower limbs.The following is the recent MRI

    MRI LUMBAR SPINE ?(?3 ?Tesla?) ?

    MRI of the lumbar spine was performed in the sagittal and axial planes using T?1 ?& ?T?2 ?weighted ? sequences?.?

    On T?2?W images hyperintense erosive lesions are noted to involve L?5?, ?S?1 ?and S?2 ?vertebral bodies with ? involvement of the intervening L?5?-?S?1 ?and S?1?-?S?2 ?intervertebral discs?. ?These lesions reveal ?hypointensity on T?1?W images?.?

    Compression fracture ?(?15?-?20?%) ?is noted at the superior endplate of S?1 ?vertebral body with no ?significant retroplusion at present scan?. ?

    Moderate to large size pre and bilateral paravertebral collection is noted extending from L?5 ?till S?2 ?vertebral levels?. ?This collection measures ?6?.?5 ?x ?6?.?0 ?x ?3?.?5 ?cms ?(?SI x ML x AP?) ?in dimension and reveal ?hypointense signal intensity on T?1?W images with hyperintense rim?. ?

    Anterior epidural extension is noted of the above mentioned collection at the level of L?5 ?and S?1 ?vertebral level?. ?This collection measures ?3?.?2 ?x ?0?.?7 ?cms ?(?SI x AP?) ?in dimensions and reveal hypointense ?

    signal intensity on T?1?W images with hyperintense rim?. ?

    On T?2?W images reduced signal intensity and height is noted of all lumbar intervertebral discs ?.

    What is your advice and what exactly the treatment will be for her.

    Please do reply me soon Sir

    Thanking you.

    With Regards

    Riya

  292. Dr Arun Pal Singh says

    @Riya,

    Pain can have many causes other than present problem. Symptomatic treatment should help her.

  293. Riya says

    Dear Sir

    My mother suffering from TB spine as i have discussed, her latest MRI has shown no reduction in abscess .She has lower back pain .AKT 3 has been stopped.She is on physiotherapy.

    I would like to know

    1)why the abscess has not reduced ,she is taking regular treatment for 15 months

    2)what would you advice?

    3)will she has to under go surgery ?

    4)is this abscess harmful to her?

    Please reply me soon very much worried

    Thanking you

    With Regards

    RIYA

  294. Dr Arun Pal Singh says

    @rashid minhaj,

    you can send your xrays and images to contact [at] boneandspine [dot] com.

    The most important thing is to know if the medications are working. Your improved symptoms would tell you.

    If you are not improving, the medicines should be checked for efficacy against your infection.

  295. Dr Arun Pal Singh says

    @Riya,

    Unreduced abscess means persistent infection and it may mean that medicines are not affecting the way they should.

    Options include surgical removal of abscess and culture and sensitivity of the pus to know what medicines are ineffective.

  296. Brian Palmer says

    I'm a missionary serving in Totota, Liberia. Roseline is a 13 year old girl who lives near me. The best guess diagnosis is she has been suffering from TB of the spine for about 20 months. Once it was obvious she was sick and not getting better (perhaps 18 months ago) she was taken to many doctors in Liberia – most of whom simply concluded she was malnourished. After her family ran out of money they sent her into the bush for traditional medicine. She stayed there for about a year while her condition deteriorated. About 4 months ago she returned from the bush and began receiving treatment for TB and has responded very, very well. What I see is:

    1) Her spine protrudes just below the base of the neck and she is somewhat hunchbacked. She was not this way a year ago.

    2) Her lower ribs protrude a lot in the front – they look like horns sticking out about 1.5 inches on each side. It seems possible to me that the problem could be that her other ribs are not out as far as they should be.

    3) She has no numbness and/or paralysis. Her back does not hurt.

    4) She is very thin – she weighs 45 lbs and is perhaps 4' 6" tall.

    My/her questions are:

    1) Is there anything I can do to confirm the diagnosis?

    2) Assuming it is TB of the spine and she is being treated properly for the infection how might I assess the extent of her deformity so we can talk about treatment options (do nothing, bracing, surgery, other?) and possible outcomes?

    3) I have stressed to the family the importance of Roseline taking her TB meds. I have also asked that she not be asked to do work that involves carrying any kind of heavy load. I have also intervened in terms of making sure she eats better as her appetite has returned.

    Is there something else she or the family or I should be doing? Medical facilities in Liberia are quite limited. Thank you.

  297. apsingh1975 says

    1) For confirmation of the diagnosis, there are many investigations that can be done but I am not sure what is available and what is not at your place. So we stick to the basics Cmplete blood count, ESR and xray might suggest the diagnosis.

    2) There appears kyphosis and scoliosis the way you are describing her deformity. Agian, xray should reveal that.
    3) You are right about this advice. TB medications, once started should be taken without fail as per the regimen. She should rest too, a lot.

    Good to hear that you are taking care of someone in need. May God bless you.

  298. shvetz says

    Hello Doctor
    Wishes for a noble benevelont work you doing.
    My Dad was diagnosed with Potts spine n had a surgery in the end of feb (l5/l6). He had lost his movement a week before the surgery n we got an MRI done n immediate treatment was started in Aiims.
    For the second due visit recently I got his LFT, platlet count n CRP done.
    His CRP count is 20. Lft/platlet count is normal. So is his sodium level count. However due to deficiency of K , we feedig him bananas.
    The new problems are…
    1.He doesnt feel hungry even a bit(surgery 22 feb,att started same time).
    2. Sometimes he doesnt realize n urinates.
    3. He sometimes gets confused with time zone he is in n thins around him(minor).Also, v mild headache occurs post meals.

    Are these normal symptoms? His movement is getting better though.

    Thanks in Advance…eagerly waiting for ur response.

  299. Dr Arun Pal Singh says

    I would suggest you to wait for few weeks and continue the treatment as advised by your doctor. For headaches/confusions you might want to consider a neurosurgeon/neurologist to rule out any tubercular lesion in the head [though quite rare].

    Overall, he seems to be responding well [gain in movements]. Give him some time. If the condition deteriorates a consultation might be warranted.

  300. ANKIT GUPTA says

    dear sir,
    i am 24 yrs old. i had been suffrering from spine tb since july 2011.my lower half body was paralysed.but now my spine tb treatment has completed. i can walk without support. but i have problem that when i walk then i afraid i will fall down.i done mri brain and spine.brain mri is tatally normal. but DORSAL SPINE MRI REPORTshows-

    ->THE CURVATURE OF THE DORSAL SPINE IS STRAIGHTENED
    ->AN OBLONG FLUID DENSITY AREA IS SEEN WITHIN DORSAL SPINAL CORD AT D3 LEVEL-? THIN SYRINX.REST OF THE DORSAL (TILL D11 LEVEL)SHOWS PRESENCE OF CORD EXPANSION WITH ABNORMAL DIFFUSE HYPERINTENSE SIGNAL ON T2WI(WITH PREDOMINANT INVOLVEMENT OF THE DORSAL ASPECT OF THE CORD).THIN SMOOTH MENINGEAL ENHANCEMENT IS SEEN THOUGHT THE ENTIRE EXTENT OF THE DORSAL CORD.
    ->DORSAL VERTIBRAL BODIES ARE NORMAL IN SIGNAL INTENSTIES AND ALIGNMENT..
    ->INTERVERTIBRAL DISC ARE NORMAL IN SIGNAL INTENSITY AND HEIGHT.
    ->PARA VERTIBRAL SOFT TISSUES APPEAR NORMAL..
    I WANT KNOW THE ACTUAL MEANING OF DORSAL SPINE REPORT.PLZ . RPLY ….

  301. Dr Arun Pal Singh says

    syrinx means their is dilation of the cord at the level.There is abnormal signal in rest of dorsal spine and shows involvement of dorsal aspect of the cord [if you divide the cord in two halves font and back, the back portion becomes dorsal aspect].

    Your cord is showing abnormal changes in dorsal aspect. Sensory input to the brain is also through dorsal portion. You can discuss with your clinician about possible relevance of the findings in your case and the described problem.

  302. Akanksha says

    Hi, I am on ATT and its been 4 months now. i have pott’s disease and L5 is infected. I was on bed rest for 2.5 months. Now i have joined back my office. Pain has reduced in L5 area but my full spine is always stiff and if i touch the spine i have slight pain. It is not unbearable but it makes me uncomfortable. Is this spine stiffness normal and part f the symptom. When is it expected to heal completely. Can i put warm pad or warm water bags in upper part of my spine to relieve my pain, as initially any kind of hot compress was not allowed by my doctor. When i lie on my back, it causes discomfort. Please advice

  303. Arun Pal Singh says

    You seem to be making a good progress and it would take a while for things to come back to normal. Keep in touch with your doctor for any specific advise.

  304. Kshitij Uttarwar says

    Hi,
    I am an Indian working in UK since last 2.5 years. I was suffering through neck pain since last 3 months and finally after the x-ray and MRI scans it was confirmed that there is some abscess formed around the neck vertebrae C3 and that vertebrae also became very thin. Doctors have drained out the abscess. I am still in hospital and sample results are yet to come. Meanwhile assuming it’s TB, Doctors have started with anti TB treatment which should go for six months. They have put the hard collar around the neck and asked to wear it for six months.
    How much is the possibility of strengthening of that bone with TB treatment, will there chance of surgery in future?

  305. Arun Pal Singh says

    Your progress with antitubercular medication would guide the physicians about whether to continue with this or add surgery as well

    With treatment, most of the patients heal well and do not have any residual complaint.

  306. Amit Singh says

    Dear Sir,
    I was diagnosed Pott’s Spine one year ago when I complained of low back pain and overall weakness for over a year before. But even after 1 year of ATT now disease progress is reported on new MRI.

    History:
    I had pulmonary TB in 2002 and took normal TB treatment for 1.5 years back then. No more problems thereafter.

    But, In Apr-2013, after low back pain, MRI (LS-spine) +whole spine screening and PET-CT scan were done and L3 showed koch’s. Immediate biopsy of L3 with bone-marrow (hip) was done. L3 tissue had positive culture, AFB stain, and all drugs were sensitive except streptomycine.

    Weight based ATT was started in apr-2013, no bed rest required and I continued normal activity using LS-belt (frame-type). Blood tests and MRI’s were repeated every 3-5 months. The L5 continued to sacrilize. There was no disease progress upto oct-2013 as per MRI studies.

    However, Oct-2013 MRI shows slight intensity on L2 but much better looking L3. Doctors choose to not worry about it and continue Rcinex-600 + B6. The PZA and ETB were stopped by end of June.

    Weight remained around 50-53 throughout this period and I had on/off low back pain. Physiotherapy was also started from may-2013 for Core strength, pelvic tilt and general muscle weakness. And I’m still on PT.

    During Dec-Mar, I had no fever but low back started to become more stiff. The apr-2014 blood tests showed ESR=53, CRP=33, no other issues. MRI was repeated for LS-spine study, whole spine + pelvis screening. Now Abscess is reported around L2-L3-L4 and right spoas muscle (blucky). Radiologist hints at Spondyliodiscitis. Still no much pain or any neuro deficit, but getting up from bed or chair causes slight upeer hip pain and disturbed gait for a minute.

    The Spine Surgeon recommended surgical debridement with bone grafts upon looking at MRI films. The infectious diseases MD is neutral about this decision. Hence I took another secondary opinions for satisfactory advised. No spine surgeon suggested debridement/bone grafts, but recommended abscess draining and tissue biopsy for more advanced tests. However, when my sister showed my reports to the top spine surgeon of apollo), he said there is no need to even drain the abscess and seek proper ID specialist antibiotics.

    I’m not able to make surgical decision. Could it be that medicines are failing or drug resistance developed? My ID specialist says I’m doing very good clinically but there is clinical-radiologic disconnect.

    I have option to go for two surgical methods for abscess draining + biopsy as described below. Please recommend one.

    [1] Usual ultrasound guided draining via abdominal cut (4+ inch) and attempt on conservative L2-L3-L4 debridement.

    [2] Endoscopic abscess draining and sampling of L3. Surgeon will attempt to drain as much possible, but not whole abscess be drained (if it is tickened). I’m not sure if this same 6mm stichless incision (over L3) will be able to drain right spoas abscess.

    The endoscopic method looks much better than traditional larger abdominal incision.

    Please let me know whether sharing the MRI, other reports will help make decision.

    Thank you and best regards

  307. Arun Pal Singh says

    Drug resistance is a possibility if the disease worsen in spite of antitubercular drugs. Debridement is always better by open methods as endoscopy would have its own limitations. However, you need to first establish if there is a drug resistance. That tissue can be obtained by endoscopy also, cultured and checked fro sensitivity.

    Take care and keep me updated. May you get well soon.

  308. anikghosh says

    Hi doctor,, I’m Anik from kolkata..recently my mother has been diagnosed with TB Spine.
    MRI report says, ” 1.Suggestion for sacralisation of L5 vertebrae.
    2.Altered L3 vertebral marrow with adjacent pre paravertebral soft tissue at L2 & L3 vertebral level likely infective etiology (? tubercular)
    3.mild diffuse disc bulge with mild bilateral neural foramina stenosis at L4-L5 and L5-S1 level”
    They also did Full body bone scan & other blood test including serum protein electrophoresis which says “suggestive of polyclonal gammopathy & No M band presnt”
    Now doctor has started AKT 4..but he have not told us when how these tablets should be taken…
    My question is ……….1.Have they diagnosed properly?
    2.direction for taking AKT 4??
    & 3.according to MRI,,she will be alright only by medication??

  309. Arun Pal Singh says

    1.If you doubts regarding diagnosis, you need to take a second opinion by getting your mother examined in person from another doctor. Because I have not examined the patient, I cannot comment on diagnosis.
    2. Directions for use would depend on the drugs she is on.
    3. It cannot be commented as it needs to be seen how does she responds to the treatment. Your doctor would be in better position to answer this after few weeks of treatment.

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