Spinal Tuberculosis (Pott's Spine) Symptoms & Treatment: A Guide for Hyderabad Patients

Key Takeaways

• Serious Condition: Spinal Tuberculosis (Pott’s Spine) is an infection that destroys the vertebrae and can lead to paralysis if ignored.
• Early Signs: Look for persistent back pain that worsens at night, low-grade fever, and unexplained weight loss.
• Curable: With early detection, 80-90% of cases are cured with medication alone.
• Treatment: Requires a long course (12-18 months) of antibiotics; surgery is only for complications.
• Urgency: Immediate consultation is needed if you experience leg weakness or numbness.

What is Spinal Tuberculosis (Pott's Spine)?

Tuberculosis (TB) is often thought of as a lung disease, but the bacteria Mycobacterium tuberculosis can travel through the bloodstream and infect the spine. This condition, known as Spinal Tuberculosis or Pott's Spine, is a major health concern in India, including here in Hyderabad.

Unlike mechanical back pain (like a slip disc), spinal TB is an infection that slowly destroys the vertebral bones. The bacteria eat away at the bone tissue, causing it to collapse. If left untreated, this can lead to a severe spinal deformity known as kyphosis (hunchback) and, more dangerously, can compress the spinal cord, leading to permanent paraplegia (paralysis of the legs).

In Hyderabad, we see a diverse range of patients affected by this—from young adults in stressful corporate jobs to elderly individuals with weakened immunity. The key is to catch it before it causes irreversible damage.

Recognizing the Symptoms: It’s More Than Just Back Pain

The symptoms of spinal TB can be subtle at first, often mistaken for general fatigue or normal backache from poor posture. However, distinguishing mechanical pain from infective pain is crucial.

Early Warning Signs (The "Cold" Phase)

At the onset, the symptoms are often non-specific. This is why many patients delay seeking help.

• Persistent Back Pain: Unlike muscle strain, this pain is deep, dull, and aching. It is localized to one specific area of the spine.
• Night Pain: A classic sign. The pain often gets worse at night or when lying down, preventing sleep.
• Constitutional Symptoms: You may experience a low-grade fever (especially in the evenings), night sweats, and unexplained weight loss or loss of appetite.
• Stiffness: You might notice a reduced range of motion. The muscles around the spine go into spasm to protect the painful area.

Late Stage Symptoms (The Danger Zone)

As the infection progresses and the bone collapses:

• Neurological Deficits: This is an emergency. Symptoms include numbness, tingling ("pins and needles"), or weakness in the legs. You might find your legs feeling heavy or dragging while walking.
• Deformity: A visible bump or prominence on the back (Gibbus deformity) indicates that one or more vertebrae have collapsed.
• Abscess Formation: "Cold abscesses" may form. These are collections of pus that can track down tissues and appear as soft swellings in the back, groin, or even the thigh (psoas abscess).

Diagnosing Spinal TB in Hyderabad

Correct diagnosis is crucial and requires a specialized approach. Many general practitioners might treat it as simple back pain for weeks before suspecting TB. At my neurosurgery clinic in Hyderabad, we follow a rigorous protocol:

1. Clinical Examination: We check for localized tenderness over the spine, any visible deformity, and perform a detailed neurological exam to test power and sensation in your legs.
2. MRI Spine: This is the gold standard for detection. An MRI scan reveals early bone destruction, involvement of the intervertebral disc (paradiscal involvement), and the presence of soft tissue abscesses. It helps us differentiate TB from spine tumors.
3. Blood Tests: Elevated Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) levels indicate active infection and inflammation in the body.
4. CT Guided Biopsy: In cases where the diagnosis is not 100% clear from the MRI, or to determine drug sensitivity, we perform a minimally invasive biopsy. Under CT guidance, a needle is inserted to take a small sample of the infected tissue. This confirms the presence of TB bacteria and helps us rule out other infections or tumors.

Treatment Options: Medication vs. Surgery

The primary goal of treatment is to eradicate the infection, preserve spinal stability, and prevent or reverse neurological deficits.

Medical Management (The Mainstay)

The vast majority of patients—nearly 80-90%—are treated successfully with Anti-Tubercular Therapy (ATT) alone.

• The Regimen: It typically involves a combination of four drugs (Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol) for the first few months, followed by a maintenance phase.
• Duration: Unlike lung TB which is treated for 6 months, spinal TB requires a longer duration, typically 12 to 18 months.
• Compliance is Critical: You must take the medicines daily without fail. Stopping early because you "feel better" is dangerous. It can lead to Drug-Resistant TB (MDR-TB), which is extremely difficult to treat and has severe side effects.
• Monitoring: Regular blood tests (Liver Function Tests - LFT) are done to ensure the medicines are not affecting your liver.

When is Surgery Needed?

Surgery is not the first line of treatment for every patient. As a neurosurgeon, I reserve surgery for specific complications where medication alone is insufficient:

1. Severe Neurological Deficit: If the patient has significant weakness (paraparesis) or paralysis in the legs. Immediate decompression can often reverse this.
2. Spinal Instability: If the vertebrae are so destroyed that the spine acts like a "broken column" and cannot support the body's weight, leading to severe pain and risk of cord injury.
3. Large Abscesses: Pus collections that compress the spinal cord and do not resolve with medicines need to be drained.
4. Failure of Medical Treatment: If pain or infection persists despite 3-4 months of correct medical therapy.
5. Severe Deformity: To correct significant kyphosis that affects balance or breathing.

In such cases, we perform Spinal Decompression and Fixation. This involves removing the infected tissue/pus (decompression) and stabilizing the spine using titanium screws and rods (fixation). In some cases, we use a bone graft or a cage to replace the destroyed vertebral body.

Recovery and Rehabilitation

Recovery from Spinal TB is a marathon, not a sprint.

• Rest: Strict bed rest is often advised initially during the acute phase to prevent spinal collapse.
• Bracing: A custom-molded spinal brace (orthosis) is usually prescribed. It acts as an external skeleton, supporting your back while the bones heal and fuse.
• Nutrition: TB is a wasting disease. A diet high in protein (eggs, paneer, pulses, meat) is essential to boost your immunity and aid tissue repair.
• Physical Therapy: Once the acute pain subsides and the spine is stable, gentle physiotherapy helps regain strength and flexibility.

Conclusion

Spinal Tuberculosis is a serious condition, but it is completely curable. The key to a full recovery without permanent deformity is early detection. The days of resulting in lifelong hunchbacks are largely behind us thanks to modern imaging and advanced medical care.

If you or a family member have persistent back pain accompanied by fever, weight loss, or any weakness in the legs, do not ignore it. Early intervention can save your spine and your mobility.

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Medical Disclaimer: The information provided in this blog post is for educational purposes only and does not constitute medical advice. Spinal Tuberculosis is a complex condition that varies from patient to patient. Always consult with a qualified neurosurgeon or spine specialist for proper diagnosis and treatment planning. Do not stop or alter your medication without medical supervision.

For expert evaluation and treatment of spinal infections, book an appointment with Dr. Sayuj Krishnan today.