Tubercular Spinal Infection
Tuberculosis used to be the main cause of infectious spondylitis. But now, effective medicine and surgery are available for treatment. Tubercular bone and joint infections are rare, accounting for only 2% to 3% of all cases of M. tuberculosis. Spinal tubercular infections make up one third to one half of these infections. The thoracolumbar spine is the most infected area. It can happen to both men and women, but the incidence of infection seems to increase with age.
Cause of infection:
The infection is caused by a bacteria that forms lumps of dead tissue in the body, and can create abscesses and skin sinuses. The infection can cause intense reactions in the bones or no reaction at all. In the spine, the infection goes under the anterior and posterior longitudinal ligaments but does not infect the intervertebral discs. Epidural infection can lead to permanent neurological damage.
Signs and symptoms of Spinal TB:
The disease starts with slow constitutional symptoms like weakness, tiredness, night sweats, fever, and weight loss. Pain is a later symptom that can cause bone collapse and paralysis. Cervical involvement can cause hoarseness, difficulty swallowing, and difficulty breathing. These symptoms can be due to abscess formation in the neck. In severe cases, erosion into the great vessels can lead to sudden death.
Symptoms of Spinal Tuberculosis
Spinal tuberculosis, also known as Pott's disease, can cause various symptoms. Neurological symptoms usually happen later and can come and go. The ability to move and rectal tone are good signs for recovery. A study found that even if 76% of the spinal canal is affected, it may not cause neurological problems. Another study found that 60% to 90% of patients with Pott paraplegia recovered with prolonged bed rest in an open-air hospital.
How it is Diagnosed
Tests can show signs of a long-lasting illness, such as anemia, low levels of protein, and slightly increased ESR. Skin tests may also help, but they are not always accurate. X-rays can show a decrease in disc spaces and bone loss. Later, they may show vertebral collapse, soft-tissue swelling, and calcification. CT scans with or without contrast can help show the problem and the degree of nerve damage. MRI scans can show more details, such as abscesses and bone fragments. Biopsy of the lesion can confirm the diagnosis, and culture of the organism can identify the type of bacteria causing the disease.
Diagnosis and Treatment
Spinal tuberculosis can be mistaken for other conditions, such as fungal or pyogenic infections, metastatic disease, or primary bone tumors. A correct diagnosis is important because the treatment requires strong medication and can take a long time. Surgery with chemotherapy can provide better results and can prevent deformity, recurrence, and paralysis. Bed rest and immobilization are not very effective. If surgery is not possible, chemotherapy can be used instead.
What are the Treatment Options For Spinal TB
Spinal TB can be treated with surgery in certain cases. Surgery is recommended when the disease affects more than one vertebra, which can cause the spine to become curved or collapse. Other reasons for surgery may include resistance to chemotherapy or the disease coming back after treatment.
Surgery may also be needed in cases of severe kyphosis (a type of spinal deformity) or signs that the spinal cord is being compressed. However, people who have heart or breathing problems may not be able to have surgery.
If a person needs surgery, the doctor may perform a procedure called an open biopsy. This involves removing a piece of tissue from the spine to check for signs of the disease. After the biopsy, the doctor may remove any infected tissue and replace it with a bone graft. They may also use instruments to stabilize the spine.
After surgery, the person may need to wear a brace to help the spine heal. The type of brace and length of time needed will depend on the location and severity of the surgery. In some cases, the person may need to wear the brace for several months to a year.