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Tuberculosis of the spine

While often associated with the lungs, tuberculosis (TB) can also affect other parts of the body, including the spine. Known as Tuberculosis of the Spine or Pott’s disease, this is a serious and debilitating bacterial infection that can cause severe back pain, destruction of the vertebrae, spinal deformity, and in advanced cases, paralysis. Due to its potential to compress the spinal cord and cause permanent neurological damage, it is a critical condition that requires the expertise of a neurosurgeon.

In Pune, India, Dr. Jaydev Panchwagh specializes in the diagnosis and surgical management of spinal infections, including tuberculosis. His comprehensive approach involves not only treating the infection but also surgically decompressing the spinal cord and stabilizing the spinal column to prevent long-term disability.

Tuberculosis of the spine

What is Tuberculosis of the Spine?

Tuberculosis of the Spine is an infectious disease caused by the bacterium Mycobacterium tuberculosis. The infection typically spreads from the lungs to the spine through the bloodstream, where it attacks the vertebrae and the intervertebral discs. Alternate pathways of seeding into the spine is also possible which leads to the destruction of the spinal bones and can cause them to collapse, resulting in:

  • Spinal Instability: The destruction of vertebrae makes the spine unstable and prone to collapse.
  • Kyphosis: The collapse of the vertebrae leads to a sharp forward-curving deformity of the spine, often causing a noticeable hump in the back.
  • Spinal Cord Compression: As the vertebrae collapse, they can press on the spinal cord and nerves, causing neurological deficits.
  • Abscess Formation: The infection can lead to the formation of a collection of pus (an abscess) that can also put pressure on the spinal cord.

The symptoms of spinal TB can develop slowly over time, making early diagnosis challenging. Common signs and symptoms include:

  • Chronic Back Pain: Persistent and severe back pain that is often not relieved by rest.
  • Constitutional Symptoms: Fever, night sweats, loss of appetite, and significant weight loss.
  • Neurological Deficits: Numbness, tingling, weakness, or a loss of sensation in the legs. In severe cases, this can lead to partial or complete paralysis.
  • Spinal Deformity: A visible kyphosis (hump) in the back, especially in children.
  • Abscess: Swelling or a cold abscess may be present on the back.

The cause of spinal TB is an infection with the Mycobacterium tuberculosis bacterium. It can affect anyone, but certain risk factors increase a person’s susceptibility:

  • Immunocompromised Individuals: People with conditions like HIV/AIDS or those taking immunosuppressive medications are at a higher risk.
  • Malnutrition: Poor nutrition can weaken the immune system.
  • Close Contact: Living in close contact with someone who has active tuberculosis.
  • Geographic Factors: The disease is more prevalent in certain regions of the world, including parts of India.

A correct diagnosis is a multi-step process that requires a high degree of clinical suspicion. Dr. Jaydev Panchwagh employs a comprehensive approach:

  • Detailed Medical History and Physical Examination: A thorough review of a patient’s symptoms, including any history of TB, and a physical exam to check for neurological deficits and spinal deformity.
  • Blood Tests: Blood tests like the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) can indicate inflammation and infection.
  • Imaging Tests:
    • X-ray: Initial X-rays may show a narrowing of the disc space and destruction of the vertebrae.
    • MRI (Magnetic Resonance Imaging): An MRI is the most valuable tool. It provides detailed images of the spinal cord, nerves, and abscesses, clearly showing the extent of the disease and any spinal cord compression.
    • CT (Computed Tomography) Scan: A CT scan provides excellent detail of the bony destruction.
  • Biopsy: A definitive diagnosis is made through a biopsy, where a tissue sample from the infected area is taken and sent to a lab for analysis to confirm the presence of the TB bacterium.

The treatment of Tuberculosis of the Spine is a combination of medical and surgical management.

  1. Medical Treatment:
    • Antitubercular Therapy (ATT): The primary treatment is a course of anti-TB medications that can last from 6 to 18 months. This is crucial for killing the bacteria and arresting the infection.
  2. Surgical Intervention:
    • When is Surgery Considered? Surgery is typically recommended for patients with significant spinal deformity, severe pain, neurological deficits, or a large abscess that is putting pressure on the spinal cord.
    • Surgical Goals: The goals of surgery are:
      • Decompression: Removing infected bone, abscess material, or other tissue that is compressing the spinal cord and nerves.
      • Spinal Stabilization: Reconstructing the spine and using a bone graft with implants (screws and rods) to stabilize the spine and prevent future collapse and deformity.

Why Choose Dr. Jaydev Panchwagh for Tuberculosis of the Spine?

 

Managing spinal TB requires a neurosurgeon with expertise in both spinal surgery and the complexities of infectious diseases. Dr. Jaydev Panchwagh in Pune, India, is a trusted choice for his:

  • Expertise in Complex Spinal Surgery: He is highly skilled in performing complex surgical decompressions and fusions for spinal infections, which are technically demanding procedures.
  • Comprehensive, Multidisciplinary Care: He works in close collaboration with infectious disease specialists and pulmonologists to ensure a holistic approach, combining medical and surgical therapy for the best outcome.
  • Focus on Preserving Neurological Function: His primary goal is to relieve spinal cord compression as soon as possible to prevent permanent neurological deficits.
  • Patient-Centric Approach: He provides a thorough evaluation and discusses the long-term nature of the treatment, ensuring patients understand the need for both surgery and prolonged medical therapy.

Frequently Asked Questions (FAQs) about Tuberculosis of the Spine

While medication is essential to kill the bacteria, surgery is often needed to address the structural problems like instability, deformity, and spinal cord compression. In these cases, medication alone is insufficient.

The recovery involves both a surgical recovery period and a long course of antibiotic treatment. Post-surgery, patients may stay in the hospital for a few days to a week. Full recovery can take months.

Surgical intervention, particularly a fusion, is designed to stabilize the spine and prevent the deformity from getting worse. In some cases, it can help to partially correct the deformity.

Tuberculosis of the spine is a serious condition, but with the right diagnosis and expert neurosurgical and medical care, it is treatable. Dr. Jaydev Panchwagh offers the expertise to guide you through this complex process.