Mangement of Tuberculosis of Spine/ Pott's Spine
Of all the bones, Spine is the most common site to suffer from Tuberculosis. Tuberculosis of Spine or TB spine is also known as Pott’s Spine. Patient usually presents with dull aching, slow onset pain which is gradually which is gradually progressive. Depending on the area involved patient may have Neck pain or Back pain along with the radiation into the arm or legs. Some of the patients present with weakness and numbness in the extremities due to Spinal cord compression. The pain of Tuberculosis of Spine is continuous and doesn’t go away with rest. It is associated with fever weight loss and loss of appetite. Diagnosis of tuberculosis is usually made on the basis of clinical findings, patient history and radiological examinations like MRI. Traditional Mantoux test is is not reliable. Blood test like Gamma interferon & TB Gold are alos not helpful in cases of Spinal Tuberculosis. MRI is the ideal radiological investigation for diagnosis. MRI can demonstrate the extent of bony and disc destruction along with epidural and Psoas Abscess. It also helps in making a differential diagnosis. However, the final diagnosis can be confirmed only by biopsy. Biopsy is the Gold Standard and the only test that can tell with hundred percent surety whether the diseases is TB or something else. Biopsy can be either USG guided drainageor CT guided Transpedicular biopsy. In few cases open biopsy under GA is needed. The Biopsy specimens are sent for histopathology, TB PCR and GENE XPERT along with TB culture & Drug sensitivity.
Treatment of of tuberculosis is primary medical that is oral tablets. Medicines need to be taken for at least nine months. A repeat MRI is done before stopping treatment to confirm that the disease is completely cured. When the patient is taking ATT i.e antitubercular drugs, regular monitoring of ESR CRP and liver function test are required.
In a few Patients with Spinal Tuberculosis, Surgery is required. These are patients with extreme Back or Neck pain with radiating pain in arm or legs along with weaknes with spinal cord compression or with loss of Urine and bladder control. During the surgery, Spinal cord is decompressed and pus is drained. The Spine is fixed with Pedicle Screws and rods, in case of Cervical Spinal Tuberculosis, plate and cage is used. Neurological recovery after surgery for spinal tuberculosis is very good provided the surgery is done early before the paralysis is complete.