BENGALURU: India with its 6 million cases of tuberculosis patients, hosts about one-fifth of the total world population suffering from TB. Out of all the TB patients, one to two per cent suffer from TB of the skeletal system. Among patients suffering from skeletal TB, more than half of the number of cases are diagnosed with TB of the spine.
Symptoms and implication of TB
Spinal TB can affect both male and female, and any age group – children, adolescents, adults, elderly. Young adults and females in the reproductive age group are more susceptible to this kind of TB. In the active stage of the disease, patients suffer from malaise, loss of weight, loss of appetite, night sweats and rise of body temperature at evening. The spine becomes stiff and aches with movement, causing localised deformity. There are persistent muscle spasms around the affected vertebrae. Spinal TB may also be associated with neurologic problems caused by compression of the spinal cord.
Causes and incidences
TB in the spine occurs when you contract tuberculosis and it spreads beyond the lungs. Spinal TB typically begins due to the rich vascular supply in the middle of the long bones and the vertebrae. The occurrence of multi-drug resistant TB poses a higher challenge to treat spinal TB adequately.
Diagnosis and treatment
Accurate clinical diagnosis of spinal TB is often difficult as symptoms may not be definitely pertaining to TB in the early stages, however MRI scans would detect the infection. In patients with spinal TB, anti-TB treatment should be started as early as possible. In patients with known difficulties of spinal tuberculosis, surgery may also be required. The treatment varies between conservative management with drugs to surgical management, or a combination of both, depending upon the severity of the disease.
Using multidrug therapy, the recurrence rate for skeletal TB is about 2 percent, although the relapse rate was much higher when treatment used to be given using a single drug. Long-term multidrug anti-TB treatment helps reduce the relapse rate of spinal TB. Effective medical and surgical management of spinal TB has improved the outcome of patients significantly even in the presence of neurologic deficits and spinal deformities.
Neurologic complications due to spinal TB can be relatively benign if early medical and surgical management is done. Younger age of the patient and radical surgery, along with anti-TB chemotherapy, can drastically improve the outcome.
Precaution and prevention
TB has devastating consequences for patients, their families and the society as a whole. Spinal TB is very painful and can leave the patient immobile. Early diagnosis is the key followed by prompt and adequate treatment can completely cure spinal tuberculosis. In neglected cases, the patient may develop angular deformity due to the destruction of vertebral bodies and lead to paralysis of legs and lower parts of the body.
The author is consultant, spine surgery, Vikram Hospital, Bengaluru