Be aware of spinal TB

Dr Satnam Singh Chhabra

Tuberculosis (TB) is generally perceived as a pulmonary disease affecting our lungs. However, this potentially serious infectious disease also affects other organs and body tissues. According to the medical statistics, five to 10 per cent of the total TB patients in India suffer from bone TB. And the figure is on a constant rise, mostly because of ignorance about bone TB. Due to this lack of awareness and information, the disease spreads silently and the bacterium causing TB affects bones and the spine. India is home to about one lakh people who suffer from osteo-articular tuberculosis which leads to limb shortening in growing children and even full body paralysis in a few cases. 

Although TB primarily affects the lungs, it can spread through the blood stream to other sites, commonly called extra-pulmonary or disseminated tuberculosis. Usually, the ends of long bones and the vertebrae are common sites by extra-pulmonary tuberculosis and the disease can hit people of every stratum, whether rich or poor. 

Though it can affect any bone, but most commonly it attacks the spine and weight-bearing joints, like hands, wrists and elbows. The type of pain, too, depends on the exact location of the tuberculosis, for instance in case of spine TB, the pain in lower back is so severe that the patient ends up seeking medical treatment. 

Proper diagnosis 

Bone TB, in its early stages, is often misdiagnosed as arthritis. Therefore, to distinguish it from arthritic pain, patients should observe the nature of pain. Most patients of arthritis experience relief at night when they lie down. Whereas for those suffering from bone TB, lying flat or on your back, increase discomfort due to increased bacterial activity. 

Diagnosis of the disease is made by X-rays and lab tests on fluid aspirated from the affected joint area. In case of spine and skeletal TB, diagnosis is to be done with the help of CT Scans and MRI reports. 

Spinal tuberculosis, also called ‘Pott’s’ disease, usually affects the thoracic part of the spine. It causes constant and unbearable back pain as the virus degrades the discs cushioning the vertebrae. TB of the joints also causes an aching pain along with stiffness. Tuberculosis osteo-myelitis, or bone infection, causes constant pain in the bone itself and can cause complications in nearby tissues, such as carpal tunnel syndrome if the wrist is affected.

When a person is affected, tuberculosis of the joints progressively destroys the joints at the hips or knees. Doctors refer to the condition as mono-arthritis because only one joint is affected. The affected joint swells and becomes painful. As a result there is stiffness in movement and range of motion is limited. In severe and chronic cases, abscesses develop in the affected joints. 

Spotting correct symptoms

Patients with TB in their bones might or might not exhibit generalised signs of tuberculosis such as fever, fatigue, night sweats and unexplained weight loss. Although about half of all patients with bone TB also have infected lungs, the disease is usually not active in lungs. This also means that most patients with bone TB do not suffer from coughing and probably do not suspect that they have tuberculosis. At times, it may take years for initial  symptoms to show. 

Also, patients with bone TB are generally not contagious because the disease spreads through coughed-up active virus particles, unless you come in contact with a patient’s pus. Bone TB may also affect the bone marrow, so only solution is timely and complete course of treatment for complete cure. Duration of treatment will depend on the location and severity of the infection. But unlike TB of lungs, bone and spine TB takes a little longer depending on the severity of infection. 

In case of bone TB, bed rest, good diet, medicines and physiotherapy can help you get back to normal life. Therefore, don’t ignore symptoms or take them lightly. Always remember, while TB usually affects the lungs, it can also infect other parts of the body including the spine, brain and kidney. If proper medical attention is not received, TB can be fatal.

Complications if not treated

Spinal tuberculosis, if left untreated, can spread from one vertebra to the next, weakening the bones and destroying the cushioning discs between the discs. In severe cases, the spine can collapse and compress the spinal cord, causing paralysis of the lower body. If spinal TB progresses to destruction of the vertebrae and discs, the bones of the spine jut forward and form a hump. Spinal TB can be extremely severe, because if not detected and treated in time, it can cause severe paralysis which may take years to get cured. 

It is curable

The treatment for normal bone TB may last at least one year. In case of spine TB causes paralysis, treatment and recovery time depends on if paralysis is mild, moderate or severe. Also, in case of MDR TB, in which patients’ fail to respond well to multi drugs, it may take longer to recover completely. The TB patients are strictly advised to complete the medication course and not leave it in between, without consulting their doctor. It is important for patients to understand that TB is curable if it is timely detected and treated well. 

— The writer is consultant, neurosurgery, endoscopic spinal surgery, endoscopic brain surgery, Sir Gangaram Hospital, New Delhi