When it comes to spinal problems, everyone (young and old) complains about backache and discomfort, especially around the lumbar region. In fact when one is in pain, one day feels like a year. In some cases, some people are forced to even quit their jobs. An example is Jean Bosco Mushyandi, 23, who resigned his job as waiter in a restaurant in Muhanga District in order to nurse his back problem. Unfortunately for him, the problem just seemed to get worse. He got partial paralysis and could no longer bend or squat hence relying on his siblings and parents for help.

"I felt a lot of pain in the lower limbs, especially in the muscles of the legs. I could not feel the lower portion of my body and in case I needed anything, I had to call someone,” he says.

Consequently, Mushyandi sought medical help from Kabgayi Hospital.

"From Kabgayi Hospital, I was transferred to Butare Hospital and eventually King Faisal Hospital Kigali where more tests were conducted. The results confirmed that I had tuberculosis of the bones,” Mushyandi says.

Mushyandi, who was operated on last week, is still recovering at the University Teaching Hospital of Kigali.

Spinal TB

Although many people think that there’s only one type of tuberculosis (the one that affects the lungs), there are other varieties of the disease and can affect any other part of the body. One such example is spinal TB — an extrapulmonary form of tuberculosis. It can attack any organ system and its signs are non-specific. 

As an example, spinal TB (Pott’s disease) usually comes in the form of back pain causing a lot of discomfort in patients.

From X ray radiography films, spines appear to show vertebral collapse that is mistaken for compression fractures, something that experts blame for delaying the true diagnosis of Pott’s disease.

Just like pulmonary tuberculosis, spinal tuberculosis has the propensity of pushing patients to the wall with symptoms such as local pain, local tenderness, stiffness and spasm of the muscles, a cold abscess, and prominent spinal deformity.

Notably, the cold abscess will slowly develop when tuberculosis infection extends to adjacent ligaments and other soft tissues.

People at risk

Dr Severien Muneza, a neurosurgeon at the University Teaching Hospital (CHUK), says people at risk of spine tuberculosis are those who experience frequent bacterial infections despite other factors also coming into play.

"Since tuberculosis is a degenerating disease condition, old people are at a higher risk but no age group is immune,” Dr Muneza says. Asked on predisposing factors to spinal TB, Muneza explains that people who participate in sports activities that involve lifting heavy weights have similar chances like the old people.

"If not monitored, heavy weights are likely to subject the spine bones to stress and sometimes may cause a rupture which consequently increases one’s chances of contracting the disease,” he explains.

He, therefore, advises that before people choose to participate in any sports activity, they should consult medical professionals.

"Good sports practices should be under the guidance of a professional trainer after consulting with a medical practitioner the appropriate weights for your body,” he adds.

Statistics show that 1 to 2.5 per cent of patients who complain of back pain have spine tuberculosis.

Experts urge the public to be cautious about any form of pain experienced by the body other than sitting back only to turn to medical facilities  when the sickness has advanced.

"Since the body is highly coordinated, any form of pain may signal danger and routine checkup should be a must. This also involves complaints of back pain that people usually consider as minor,” Dr Muneza adds.

Similarly, Dr Emmy Agabe Nkusi, a consultant of neurosurgery at King Faisal Hospital Kigali, advises that back pain which causes reasonable discomfort in the night is not worth neglecting.

"The back pain which comes along with fever, stress and night sweats may spell trouble for spine tuberculosis,” Nkusi says.

Although some people may have spine tuberculosis without presenting any significant symptoms, Dr Nkusi insists that routine medical checkup is necessary if diseases are to be detected at an early stage.

"The duration of treating spine tuberculosis is much longer and early detection is very helpful. Treatment on antibiotics usually takes 12 months hence as soon as you experience a back problem, always endeavour to see a doctor,” he adds.

Managing spine tuberclosis

Josee Mugendaneza, a nursing officer at CHUK, neurosurgery department, says managing spine TB is possible and patients should always focus on early detection.

Patients with spinal TB problems are watched over by health professionals almost all the time to monitor medical adherence and full recovery.

"We change the positions of the patient every two hours and it is also a must to see the progress and how they adhere to medication,” Mugendaneza explains.

Unlike pulmonary tuberculosis, spine TB is not contagious but treating it may involve a combination of surgical procedures and antibiotics to ensure complete recovery. Patients are given special care during treatment, experts say.

Mugendaneza adds that after surgical procedures most patients leave the hospital after about four weeks.

"Each month, we get like 10 patients with spinal tuberculosis but after a few weeks they leave the hospital fully recovered,” she adds.

Spinal TB is among the major causes of back pain and even without HIV&AIDS, it is still possible to acquire tuberculosis at any age because the disease only takes advantage of weakened immunity.

In Rwanda, TB mortality rate currently stands at 10 out of every 100,000 people, according to the 2013 World Health Organisation report. About 6,000 TB cases were registered countrywide in 2013. And 2,000 of them are in Kigali alone.