Diagnosis & management of SPINAL TB

While those of us who thought TB is a pulmonary disease affecting our lungs need to think again! According to the medical statistics, 5-10 per cent of the total TB patients in India suffer from bone TB and the figure is on constant rise, more due to ignorance about bone TB, during which the bacterium causing TB affects bones and the spine. In fact, if we talk about numbers, India is home to about one lakh people who suffer from osteoarticular tuberculosis which leads to limb shortening in growing children and full body paralysis in a few cases.

Although TB, primarily affects the lungs, it can spread through the blood stream to other sites, commonly called extrapulmonary or disseminated tuberculosis. Usually the ends of long bones and the vertebrae are common sites of extrapulmonary tuberculosis and the disease can hit people of every strata, no matter whether they are rich or poor. Also, it can affect any bone, but most commonly it attacks the spine and weight-bearing joints, like hands, wrists and elbows. The type of pain too depends on the exact location of the tuberculosis, for instance in case of spine TB the pain in lower back is so severe that the patient ends up seeking medical treatment. How to diagnose spinal TB properly? Bone TB in its early stages is often misdiagnosed as arthritis.

Therefore, to distinguish it from arthritic pain, patients should observe the nature of pain. Most patients of arthritis experience relief at night when lying down. Whereas for those suffering from bone TB, lying flat increases discomfort due to increased bacterial activity. Diagnosis of the disease is made by X-ray and lab tests on fluid aspirated from the affected joint area. While in case of spine and skeletal TB, diagnosis are to be done with the help of CT Scans and MRI reports. Spinal tuberculosis, also called “Pott’s” disease, usually affects the thoracic part of the spine. It causes constant and unbearable back pain as the virus degrades the discs cushioning the vertebrae.

TB in the joints also causes an aching pain along with stiffness. While Tuberculous osteomyelitis, or bone infection, causes constant pain in the bone itself and can cause complications in nearby tissues, such as “carpal tunnel syndrome” if the wrist is affected. When a person is affected, tuberculosis of the joints, progressively destroys the joints at the hips or knees. Doctors refer to the condition as “mono-arthritis” because only one joint is affected. The affected joint swells and becomes painful. With the result there is stiffness in movement and range of motion is limited. In severe and chronic cases, abscesses develop in the affected joints. What are the complications if left untreated? Similarly, spinal tuberculosis, if left untreated, can spread from one vertebra to the next, weakening the bones and destroying the cushioning discs between them. In severe cases, the spine can collapse and compress the spinal cord, causing paralysis of the lower body.

And if spinal TB progresses to destruction of the vertebrae and discs, the bones of the spine jut forward and form a hump. Spinal TB is severe because if not detected and treated in time, the disease can cause severe paralysis which may take years to get cured. How to identify the correct symptoms? Patients with TB in their bones might or might not exhibit generalised signs of tuberculosis such as fever, fatigue, night sweats and unexplained weight loss.

Although about half of all patients with bone TB also have infected lungs, the disease usually is not active there which also means that most patients with bone TB do not suffer from coughing and probably do not suspect that they have tuberculosis. At times it may take years to start showing its initial symptoms. Also, patients with bone TB are generally not contagious because the disease spreads through coughed up active virus particles unless you come in contact with a patient’s pus. Another important point to remember is that bone TB may affect the bone marrow, so timely and complete course of treatment can only cure the patients. Duration of treatment will depend on the location and severity of the infection. But unlike TB of lungs, Bone and Spine TB takes a little longer depending on the severity of infection. Is spinal TB curable?

The treatment for normal bone TB may last at least one year and in case of Spine TB causing paralysis treatment and recovery time depends if paralysis is mild, moderate or severe. Also, in case of MDR TB, in which patients fail to respond well to multi drugs, it may take longer to recover completely. The TB patients are ‘strictly’ advised to complete the medication course and never to leave it in between, without consulting their doctor. It’s important for patients to understand that TB is curable if it is timely detected and treated well. In case of Bone TB, bed rest, good diet, medicines and physiotherapy can help you get back to normal life. Therefore, don’t ignore symptoms or take them lightly. Always remember, while TB usually affects the lungs, it can also infect other parts of the body including the spine, brain and kidney. If proper medical attention is not received, TB can be fatal. (The author is Head Neuro and Spine department, Sir Gangaram Hospital)