Spinal Tuberculosis - Symptoms, Risk factors and Treatment

Spinal tuberculosis or pott’s disease is a painful disease that affects the spine caused by a bacteria- Mycobacterium tuberculosis.

Tuberculosis is a highly infectious disease that primarily affects the lungs and spreads from person to person through the air.  After affecting the lungs, the infection can spread anywhere in the body such as the brain, kidneys, bones, reproductive organs, or the spine through blood or lymph. 

Pakistan bears a huge load of tuberculosis. According to an estimate, almost 510,000 people are diagnosed with it each year in the country. Moreover, 15000 of them turn into multidrug-resistant tuberculosis, making it more difficult to treat.

In pott’s disease, the infection gets spread to the spine, usually via blood (hematogenous spread) due to the rich blood supply of the vertebrae.

Risk factors for getting spinal tuberculosis:

Spinal tuberculosis is not a very common disease, but its incidence has increased since the increase in AIDS cases. Certain risk factors increase the risk of getting tuberculosis and its spread within the body:

Poverty and overcrowding: Living in overcrowded places favors the transmission of various infectious diseases like tuberculosis from one person to another.

Malnutrition: Lack of proper nutrition can cause a weakened immune system which can cause different infections to take place and spread to different areas of the body such as spinal tuberculosis.

Illiteracy and lack of awareness: In an illiterate population, the risk of tuberculosis and spinal tuberculosis is increased. Lack of awareness causes a person not to show adequate precautions in preventing disease and delay in seeking medical help.

Alcohol and drug abuse: The risk of getting tuberculosis is higher in people who have a history of alcohol and/or drug abuse as their immune system may be weak due to malnutrition. Moreover, IV drug abuse can serve as a medium for getting an HIV infection which causes AIDS, a disease in which the immune system becomes very weak.

Immunosuppressive diseases: Any condition that causes the immune system to be suppressed causes different bacteria to infect an individual as the immune system is responsible for fighting off different infections. Conditions like AIDS, cancer chemotherapy, diabetes, and others can predispose a person to catch infections like tuberculosis.

Symptoms of spinal tuberculosis:

Spinal tuberculosis may remain asymptomatic for a long period of time and show symptoms usually when the disease becomes advanced. It may show the following symptoms:

• Severe back pain
• Back stiffness
• Tenderness of the back
• Humping of the back

Other than that, symptoms of pulmonary tuberculosis may appear such as:

• Malaise
• Weight loss 
• Fever
• Loss of appetite 
• Night sweats
• Cough with sputum or blood
• Chest pain

Diagnosis of spinal tuberculosis:

Spinal tuberculosis can be diagnosed by the following techniques :

• History
• Physical exam
• X-ray
• CT scan
• Tuberculin skin test
• Biopsy of the spine 

Treatment of spinal treatment:

The treatment of spinal treatment may involve:

Anti-tuberculosis drugs: Anti-tuberculosis medications are given to clear up the infection.

Surgical debridement: In this treatment, the focus of infection is removed surgically.

Laminectomy: It is a procedure in which a piece of all of the vertebrae is removed.

Complications of spinal tuberculosis:

The complications of spinal tuberculosis may involve:

Paraplegia: This means loss of sensation and paralysis of both legs. 

Spinal deformity: This means deformity of the spine. The spine may arch back- a condition known as kyphosis. If treatment of kyphosis is delayed, it can have its own complications such as dysfunctional breathing, costo-iliac impingement - a condition which causes back pain.

Spinal abscess: It is a collection of pus in the spine that can cause mobilizing deformities.

Conclusion

Spinal tuberculosis is a painful condition and a part of extrapulmonary tuberculosis. Immunodeficiency can increase the risk of pulmonary tuberculosis spreading. Timely diagnosis and treatment of pulmonary tuberculosis can prevent spinal tuberculosis.