Courtesy: Rishi Mugesh Kanna, Ganga Hospital, Coimbatore, India

 

Tuberculosis of the Spine (Pott’s Spine)

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Overview

• Spinal Tuberculosis is a form of extrapulmonary tuberculosis
• Remains a major global health problem
• Associated with:
  • Significant morbidity
  • Risk of neurological deficit

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Clinical Importance

• Early diagnosis prevents:
  • Deformity
  • Neurological complications
• Most cases are treatable with medical therapy

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Etiology and Pathogenesis

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Causative Organism

• Mycobacterium tuberculosis

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Unique Characteristics

• Lipid-rich cell wall:
  • Resistant to antibiotics
  • Evades immune response
• Slow-growing organism:
  • Delayed diagnosis
  • Prolonged treatment

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Spread of Infection

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Primary Source

• Usually begins in:
  • Lungs

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Mode of Spread

• Hematogenous dissemination

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Spinal Involvement

• Vertebral body infection
• Progressive bone destruction
• Possible spinal cord compression

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Pathology

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Key Processes

• Macrophage activation
• Granuloma formation
• Caseous necrosis

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Result

• Bone destruction
• Vertebral collapse
• Deformity (kyphosis)

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Clinical Features

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Common Symptoms

• Persistent back pain
• Low-grade fever (often evening rise)
• Weight loss
• Weakness
• Night pain

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Neurological Features

• Radiculopathy
• Myelopathy
• Weakness or paralysis

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Advanced Disease

• Spinal deformity
• Difficulty walking
• Paraplegia

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Diagnosis

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Clinical Evaluation

• History and physical examination

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Laboratory Tests

• ESR (often elevated)
• CRP

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Imaging

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X-ray

• Detects late-stage changes

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CT Scan

• Bony destruction
• Structural details

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MRI (Best Modality)

• Early detection
• Soft tissue involvement
• Neural compression

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Definitive Diagnosis

• Biopsy + microbiological confirmation
• Histopathology

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Modern Diagnostic Tools

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• PCR (rapid detection)
• Molecular techniques
• Drug sensitivity testing

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Management

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1. Medical Management (Primary Treatment)

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Anti-Tubercular Therapy (ATT)

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Key Points

• Long-term therapy (months)
• High success rate if compliant

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2. Surgical Management (Selected Cases)

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Indications

• Neurological deficit
• Severe deformity
• Spinal instability
• Failure of medical treatment

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Surgical Approaches

• Anterior approach
• Posterior approach
• Combined approach

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Goals of Surgery

• Decompress spinal cord
• Stabilize spine
• Correct deformity

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Challenges in Management

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• Multidrug-Resistant Tuberculosis (MDR-TB)
• Delayed diagnosis
• Prolonged treatment duration
• Risk of permanent neurological damage

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Key Takeaways

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• Early diagnosis is critical
• Diagnosis requires:
  • Clinical
  • Radiological
  • Laboratory correlation

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• Most patients respond well to:
  • Medical therapy

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• Surgery is reserved for:
  • Complicated cases

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Final Message

• Prompt recognition and timely treatment can prevent severe deformity and neurological deficits