The tiny germ mycobacterium is commonly known for infecting lungs and causing pulmonary T.B. But apart from the lungs, it has the ability to spread in the body and affect any small or big part of the body. Backbone is one part which when affected, causes much suffering to the individual. T.B. germs can travel to the back bone via blood stream from the lungs or lymph nodes, where they may be lodged. . The lymph stream from adjacent parts, carrying the germs can also take them to the back bone. Sometimes, the microbes may go directly from internal parts like lungs to their coverings and from there to the spine by direct spread. Another name for this malady is, ”Pott’s disease”, named after Percival Pott (1714-1788), who was a surgeon in London. In developing countries, Pott’s diseases represents about 2% of cases of tuberculosis. It is more common in adults than children, more in males than females, probably due to greater risk of exposure to T.B. in males due to their outdoor habits. HIV infection, poor socioeconomic conditions are yet other risk factors for T.B. of the spine like T.B. anywhere. Most commonly the upper part of backbone in thoracic cage or lumbar region are affected. The hips and knees can also be affected due to direct spread. The person may have low grade fever in evening, sweating, loss of appetite and weight or no symptoms at all. Affection of joints of backbone leads to chronic back pain which is aggravated on walking and bending. In advanced cases, even sleeping becomes difficult as turning aggravates pain. If more than one vertebral body is involved, they usually collapse, causing deformity and disability. If the spinal cord or its nerves are compressed, an individual may develop tingling, numbness, e.t.c. abnormal sensations. In advanced cases, one may develop paralysis of the limbs and fecal and urinary incontinence. Microbes of T.B. if not checked, when in spine can go to other parts of body notably the brain, causing severe headache and multiple neurological deficits Diagnosis of spinal T.B. needs high degree of suspicion. A person having unexplained back pain and/or deformity with or without fever and anorexia should be screened for Pott;s spine. Imaging techniques like X-ray of the spine and C.T. scan help in diagnosis. If there is a confirmed case of pulmonary T.B. in the family, other family members should take due precaution and get tested for T.B. It so happens that long after a person suffering in the family from T.B. has finished his treatment and improved, another family member may develop T.B. He may have been exposed to the germs much earlier but since the disease is slowly progressive, it can manifest much later. Treatment of T.B. of the spine is same as T.B. of any other part of the body, i.e. chemotherapeutic drugs in fixed doses and combinations for 6 months. Here if needed, drugs are given for a longer time. As such an individual has to be counseled for being compliant with anti T.B. therapy for entire duration, this is more important for Pott’s spine. As soon as a person starts feeling good, he tends to stop medication thinking that it is no longer needed. But the microbes persist and tend to become resistant to the drugs. Untreated, T.B. of the spine can damage the bones permanently along with spinal cord and nerves. Nutritional supplements are very useful for these patients on anti-T.B. therapy for Pott’s spine . Otherwise if a person develops parasthesias, it becomes difficult to decide whether it is due to progression of damage to spinal cord or side effect of Isonex(one of the chemotherapeutic drug). Splinting of the back by belt, use of hard bed and avoiding bending movements help to keep the pain to the minimum. Physiotherapy after finishing treatment helps to reduce the residual pain and disability. Individuals having extensive damage to the backbone need surgical correction. If a person has unexplained back pain and or neurological deficits, he should always be screened for T.B. of the backbone or Pott’s spine. Timely treatment can help prevent chronic deformity and disability. –rachna212002@yahoo.co.uk
