SPINAL TUBERCULOSIS

Spinal tuberculosis causes the destruction, collapse of vertebrae, and angulation of the vertebral column. This condition, also known as Pott’s disease, can affect any bone, or vertebra, in your spine—and it often involves more than one vertebra. The progression of this illness is slow and insidious. The total duration of the illness varies from a few months to a few years, with an average disease duration ranging from 4 to 11 months

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Spinal Tuberculosis

Spinal tuberculosis, also known as Pott’s disease, is a bacterial infection that affects the spine. It is caused by the bacterium Mycobacterium tuberculosis and is most commonly found in developing countries with poor hygiene.

Pott’s disease is the most common form of tuberculosis involving the bones. While tuberculosis is often thought of as a lung disease, it can spread to other parts of the body, including the spine. Globally, tuberculosis affected an estimated 10.6 million people in 2022, making spinal involvement a significant health concern in many regions. Children and adults alike can be affected, especially in areas where TB is prevalent and healthcare resources are limited.

It’s important to know that while tuberculosis in the lungs is contagious—meaning it can spread from person to person through the air when someone coughs or talks—spinal tuberculosis itself is not contagious. By the time tuberculosis has settled into the bones and spine, it is no longer active in the lungs and cannot be passed to others through everyday contact. So, if your child has been diagnosed with spinal tuberculosis, they are not a risk to classmates or family members in terms of spreading the disease.

The initial infection typically starts in the lungs, but once it spreads to the spine, it behaves differently and does not transmit to others.

What is drug-resistant Spinal Tuberculosis, and how is it managed?

In some cases, the standard antibiotics used to treat Spinal Tuberculosis (such as isoniazid and rifampicin) may not be effective because the bacteria have developed resistance—this is known as drug-resistant TB. This form of the disease can be more challenging to treat, but there are still options available.

Treatment for drug-resistant Pott’s disease typically involves a longer course (often 18-24 months) of second-line medications, which may include:

Injectable antibiotics like amikacin or capreomycin
Medications such as fluoroquinolones (e.g., levofloxacin or moxifloxacin)
Additional agents like kanamycin or pyrazinamide

Managing drug-resistant spinal TB often demands closer monitoring for medication side effects, as well as regular follow-up with your healthcare team. In rare instances, surgery might be needed to support the spine or relieve nerve compression. With careful supervision and adherence to the prescribed regimen, many children recover well, but early identification and specialist care are essential.

QUESTIONS AND ANSWERS

What is Spinal Tuberculosis, and how did my child contract it?

Spinal Tuberculosis, also known as Pott’s disease, is a form of tuberculosis that affects the spine. It is caused by the bacteria Mycobacterium tuberculosis. The bacteria usually spread through the bloodstream from other parts of the body, most commonly the lungs. The infection in the spine can lead to the destruction of vertebral bodies and surrounding tissues. Transmission occurs through the inhalation of respiratory droplets from an infected person.

What are the treatment options for Spinal Tuberculosis in children, and what is the prognosis?

The treatment for Spinal Tuberculosis typically involves a combination of antibiotics (such as isoniazid, rifampicin, pyrazinamide, and ethambutol) taken for an extended period, often six to nine months. In some cases, surgery may be necessary to stabilize the spine or drain abscesses. The prognosis for Spinal Tuberculosis can be favorable with early and appropriate treatment. Compliance with the prescribed medication is crucial for successful outcomes. Regular follow-up with healthcare providers is necessary to monitor progress and address any complications.

How can we support our child during the treatment, and are there any long-term effects or complications to be aware of?

- Supporting your child during Spinal Tuberculosis treatment involves ensuring they take their medications as prescribed, attending follow-up appointments, and maintaining a balanced diet for optimal recovery. It’s important to create a supportive and reassuring environment for the child.
  Long-term effects and complications can vary but may include residual spinal deformities, neurological deficits, or joint stiffness. However, with prompt and adequate treatment, the risk of severe complications is significantly reduced. Regular check-ups with the healthcare team will help monitor your child’s progress and address any emerging issues.
  
  It’s important to understand that, if left untreated, spinal tuberculosis (Pott’s disease) can cause significant damage to the bones in the spine. The infection can create inflammation and pus-filled pockets (abscesses), which put pressure on spinal structures and may weaken or even collapse the vertebrae. This process can lead to spinal instability and result in kyphosis—a noticeable curvature of the spine that can create a hunched-over appearance.
  
  Potential complications to watch for include:
  - Difficulty moving or walking
  - Nerve compression, which can cause weakness, numbness, or loss of bladder or bowel control
  - Paralysis in severe cases
  - Spread of infection to other organs, such as the brain or kidneys
  Early diagnosis and consistent treatment are crucial to preventing these outcomes. With the right care and support, most children recover well and can return to normal activities.

It’s crucial to note that specific medical advice and information should come from the child’s healthcare provider, as individual cases can vary, and the healthcare team will have the most accurate and personalized information about the child’s condition.

The doctors at the Medical City Children’s Orthopedics and Spine Specialists Practice only treat children. As such, our doctors have become experts with children and adolescents and treat their bodies and spinal tuberculosis. We urge parents to bring their children to us to ensure proper treatment and healing.

Spinal Tuberculosis Symptoms

Spinal tuberculosis can cause a range of symptoms that may vary depending on the severity and stage of the disease. Here are some of the most common symptoms:

Back pain: This is the most common symptom of spinal tuberculosis. The pain is usually felt in the middle or lower back and can be persistent or intermittent. It can get worse with movement or pressure.
Stiffness: Spinal tuberculosis can cause stiffness in the back, making it difficult to move or turn the body. This stiffness may seem more noticeable in the morning or after prolonged periods of inactivity.
Loss of mobility: In advanced stages of the disease, spinal tuberculosis can cause a loss of mobility and range of motion in the spine. This can make it difficult to perform daily activities or maintain good posture.
Deformity: Over time, spinal tuberculosis can cause the vertebrae to collapse or fuse. This will lead to a curvature of the spine or a hunched posture.
Nerve compression: Spinal tuberculosis can compress the nerves that run through the spinal column. This will lead to numbness, tingling, or weakness in the arms or legs. In severe cases, this can lead to paralysis.
Fever and weight loss: Spinal tuberculosis can cause a fever and significant weight loss, especially in advanced stages of the disease.
Night sweats: Some people with spinal tuberculosis may experience night sweats, which are excessive sweating that occurs during sleep.

Conclusion

Living with spinal tuberculosis can be challenging. The symptoms can affect your ability to sit comfortably, move your arms and legs, and go about your normal routine without pain or discomfort. In some cases, treatment may take several months or even years as the infection is slowly cleared from your body. Some people may require surgery to repair damage in the spine, which can feel overwhelming and may limit participation in regular activities and time with loved ones until recovery progresses.

It’s important to remember that help is available and you’re not alone in facing these challenges. A healthcare provider can help you manage spinal tuberculosis, ease your symptoms, and prevent serious complications.

Spinal Tuberculosis Diagnosis

Doctors may find Spinal tuberculosis challenging to diagnose because the symptoms can mimic other spinal conditions. However, there are several steps that a doctor will typically take to diagnose the disease. These include:

Medical history: The doctor will start by asking the patient about their medical history. The doctor will include any previous tuberculosis infections or exposure to the disease.
Physical exam: The doctor will perform a physical exam to assess the patient’s range of motion. The exam will look for signs of spinal deformity, and check for tenderness or swelling in the affected area.
Imaging tests: To confirm spinal tuberculosis, the doctor will typically order imaging tests such as X-rays, MRI, or CT scans. These tests can show the extent of spinal damage and help the doctor identify any abscesses or swelling.
Laboratory tests: The doctor may order laboratory tests such as blood tests and sputum tests. The doctor may also order a biopsy of the affected area to check for the presence of tuberculosis bacteria.
Tuberculin skin test: The doctor may perform a tuberculin skin test to check for the exposure to tuberculosis bacteria. This involves injecting a small amount of purified protein derivative (PPD) under the skin and checking for a reaction.
PPD Blood Test: Quantiferon-TB Gold Test (QFT-GIT) can also be used to detect the presence of tuberculosis bacteria in the blood.
Spinal fluid analysis: If there is a suspicion that tuberculosis has spread to the brain or spinal cord, a spinal fluid analysis can be conducted.

Double Checking the Diagnosis

It’s important to note that Pott’s disease symptoms can closely resemble those of other, more common spinal or musculoskeletal conditions. For this reason, spinal tuberculosis is often overlooked or misdiagnosed, especially in its early stages. In addition to the steps above, doctors may use further imaging such as positron emission tomography (PET) scans to help distinguish spinal TB from similar conditions.

Because spinal tuberculosis is rare—especially in regions with better access to healthcare—delays in diagnosis can occur. This is particularly true in parts of the world where tuberculosis is more common and resources for advanced medical testing may be limited. As a result, some patients may not receive a correct diagnosis until complications, like spinal deformity or neurological symptoms, develop.

Based on the results of these tests, the doctor can confirm a diagnosis of spinal tuberculosis.

Questions for the Doctor What questions should we ask our healthcare provider about Pott’s disease?

When your child is diagnosed or suspected of having spinal tuberculosis, it’s essential to have open communication with your healthcare team. Here are some helpful questions you might consider asking during your visit:

What tests will confirm whether my child has Pott’s disease or another spinal condition?
What is the recommended course of treatment, and how long will it take?
Are there possible side effects from the medications, and how can we manage them?
Will my child need surgery, or is medication alone likely to be effective?
What signs should we watch for that might indicate complications or the need for urgent care?
How often will follow-up visits or imaging be necessary to monitor recovery?
Are there activities my child should avoid during treatment?
What steps can we take at home to support my child’s healing and comfort?

Asking these questions can help you better understand your child’s care plan and ensure you’re fully prepared for each stage of treatment.

Spinal Tuberculosis Treatment

Non-surgical treatment options for spinal tuberculosis include a long-term course of antibiotics. Long term typically means 9-12 months, to kill the bacteria causing the infection. The antibiotics used in the treatment of this disease are different than other forms of tuberculosis. The treatment may require a combination of multiple antibiotics to effectively eradicate the bacteria.

Other non-surgical treatments include:

rest
physical therapy
pain management to manage symptoms and improve mobility.

In cases where spinal tuberculosis has caused deformities or is at risk of causing paralysis, doctors will recommend surgery. Surgery may involve removing the infected tissue and stabilizing the spine with metal plates or rods. In cases where there is a spinal deformity, surgery may involve a spinal fusion to correct the deformity and stabilize the spine.

In some cases, surgery may also be used to drain any abscesses or fluid collections that have formed in the spine as a result of the infection. The choice of surgical or non-surgical treatment options for spinal tuberculosis will depend on the severity of the infection and the individual needs of the patient. A healthcare provider will determine the most appropriate treatment plan based on a thorough evaluation of the patient’s condition.

While most children with Spinal Tuberculosis respond well to these medications, it’s important to note that a complete cure isn’t always possible in every situation—particularly if the tuberculosis is drug-resistant. Early diagnosis and strict adherence to the treatment plan offer the best chance for a full recovery, but drug-resistant forms of TB may require different medications and longer courses of therapy.

Close monitoring and consistent communication with your healthcare team will help ensure the best possible outcome for your child.

Recovery From Spinal Tuberculosis

Recovery time for spinal tuberculosis depends on the severity of the infection and the extent of damage to the spine. Antibiotic treatment may take several months to a year, and surgery may require a longer recovery period. It is important to follow the treatment plan recommended by a healthcare provider and attend all follow-up appointments to monitor progress and ensure proper healing.

Spinal tuberculosis can be categorized into two types: non-neurological and neurological.

Non-neurological spinal tuberculosis affects the bones and joints of the spine, while
Neurological spinal tuberculosis affects the spinal cord and nerves.

Non-neurological spinal tuberculosis typically presents with back pain, stiffness, and swelling, and may progress to cause a deformity of the spine. Neurological spinal tuberculosis, on the other hand, may cause numbness or weakness in the arms or legs, difficulty walking, and loss of bladder or bowel control.

Prevention Measures

Prevention measures for spinal tuberculosis include maintaining good hygiene practices, such as washing hands regularly and avoiding overcrowded living conditions. Also, vaccinations for tuberculosis are also available, and it is important to get regular check-ups with a healthcare provider to monitor for signs of infection.

While it’s not possible to completely prevent Pott’s disease, you can reduce your risk by:

Avoiding prolonged, close contact with individuals who have an active tuberculosis infection.
Getting tested for TB regularly, especially if you have an increased risk or live in regions where TB is more common.

Taking these steps can help lower your chances of developing spinal tuberculosis and support early detection if exposure does occur.

What factors influence life expectancy after a Pott’s disease diagnosis?

Life Expectancy After Spinal Tuberculosis

Life expectancy after a diagnosis of Pott’s disease (spinal tuberculosis) depends on several key factors. Early detection and prompt, effective treatment greatly improve outcomes, allowing many children to go on to lead healthy lives. However, certain circumstances can make recovery more challenging:

Age and overall health: Young children, older adults, and individuals with weakened immune systems (such as from malnutrition or chronic illness) may face a greater risk of complications.
Timeliness of treatment: The sooner the proper medication and care are started, the better the prognosis. Delayed diagnosis or treatment can lead to more severe damage and lower odds of a full recovery.
Severity and extent of infection: The degree of spinal involvement, presence of deformity, and whether nerve compression has occurred all play a role in long-term health.
Complications: Problems like persistent neurological deficits, abscesses, or resistance to TB medications may affect the outlook.
Medication response: If the tuberculosis bacteria are resistant to the standard antibiotics, management can become more complex and outcomes less predictable.
Access to specialized care: Regular follow-up with your healthcare provider, physical therapy, and nutritional support can make a significant difference in helping your child recover fully.

Your child’s doctor is the best source for personalized information, and regular check-ins throughout treatment will help ensure any complications are detected and addressed early.

Why Choose Medical City Children’s Orthopedics and Spine Specialists

Orthopedics is a specialty of our doctors and surgeons at Medical City Children’s Orthopedics and Spine Specialists. They understand your concerns and can answer your questions regarding your child’s condition. Their excellence allows them to use their specialized knowledge and training to find a medical solution. Richard Hostin, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD, specialize in children and are considered to be the very best by many children’s doctors.

Patients choose Medical City Children’s Orthopedics and Spine Specialists because of their excellence. Secondary reasons are as follows:

Cutting-edge technology: Our practice uses the latest technology and techniques to diagnose and treat a wide range of conditions. In addition, we use minimally invasive procedures that reduce pain and promote faster recovery.
Comprehensive care: Our practice offers a full range of services, from diagnostic imaging and physical therapy to surgery. We ensure that patients receive complete, seamless care for their spinal conditions.

Our board-certified physicians and fellowship-trained orthopedic surgeons use the full range of treatments to treat their patients. Medical City Children’s Orthopedics and Spine Specialists are medical experts with offices in Dallas, Arlington, Flower Mound, Frisco, and McKinney, TX, and offer cutting-edge technology, comprehensive care, and dedicated facilities to ensure the best possible care for their patients. Call today to make an appointment for your child.

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National Institute of Health: Spinal Tuberculosis

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