Dr. Jayesh Pawar

responsible for pulmonary tuberculosis. The primary ways the bacteria lead to spinal TB are:

• Hematogenous Spread: The most common route of infection is through the bloodstream. The bacteria can spread from a primary TB infection in the lungs (pulmonary TB) or other parts of the body to the spine. This process is known as haematogenous dissemination. Once in the bloodstream, the bacteria can reach the vertebrae and start infecting the spinal structures.
• Direct Extension: In some cases, spinal TB can arise from a primary infection located near the spine, such as in adjacent soft tissues or bones, through direct extension. This is less common but can occur if the infection spreads directly from a nearby site.
• Contiguous Spread: TB can also spread to the spine from nearby infected structures or tissues. This transmission mode is less frequent but can happen in cases with a severe localised infection close to the spinal column.
• Immune System Factors: Individuals with weakened immune systems, such as those with HIV/AIDS, diabetes, or other conditions that compromise immunity, are at higher risk of developing spinal TB. A weakened immune response can make it easier for the bacteria to establish an infection in the spine.

Understanding these causes is crucial for prevention and early detection of spinal TB, especially in individuals with risk factors or a history of tuberculosis.

• Back Pain: Persistent, deep-seated back pain is often the first symptom. The pain may be localised to the spine or radiate to other areas.
• Stiffness and Limited Mobility: Patients may experience stiffness in the back and difficulty moving, especially in the morning or after periods of inactivity.
• Fever and Night Sweats: Systemic symptoms such as low-grade fever, night sweats, and general malaise can accompany spinal TB, similar to other forms of tuberculosis.
• Weight Loss: Unexplained weight loss and loss of appetite are common, as the body fights off the infection.
• Neurological Symptoms: If the infection affects the spinal cord or nerves, symptoms may include numbness, tingling, weakness in the limbs, or even paralysis.
• Deformity: Advanced spinal TB can cause deformities such as kyphosis (hunchback) due to vertebral collapse and spinal instability.
• Abscess Formation: In some cases, paravertebral abscesses (abscesses adjacent to the spine) can form, leading to additional symptoms like a visible swelling or tenderness in the back.
• Spinal Instability: Severe cases can result in instability of the spine, making the spine more prone to fractures or deformities.

laboratory tests. Here’s a typical diagnostic approach:

• Clinical Evaluation: The process begins with a thorough medical history and physical examination. The doctor will assess symptoms like back pain, stiffness, neurological deficits, and systemic symptoms such as fever and weight loss.
• Imaging Studies:
  X-rays: Initial imaging with X-rays can reveal vertebral body destruction, disc space narrowing, and spinal deformities. However, X-rays may not always show early changes. MRI (Magnetic Resonance Imaging): MRI is more sensitive and can provide detailed images of the spine, showing abscesses, disc involvement, and spinal cord compression. It helps assess the extent of the infection and any associated complications. CT Scan (Computed Tomography): CT scans can be used to evaluate the bony structures of the spine and to guide biopsy procedures if necessary.
• Laboratory Tests:
  Tuberculin Skin Test (TST): A skin test to check for exposure to TB bacteria. While useful, it is not definitive for spinal TB since it only indicates past or present TB exposure. Quantiferon-TB Gold Test: A blood test that detects TB infection by measuring the immune response to specific TB proteins. Blood Tests: General blood tests may reveal anaemia, elevated inflammatory markers (such as ESR or CRP), and other signs consistent with infection.
• Microbiological Tests:
  Biopsy: A biopsy of affected spinal tissue, often guided by imaging, can confirm the presence of Mycobacterium tuberculosis. Tissue samples may be obtained via needle aspiration or during surgery. Culture and Sensitivity: Culturing the biopsy sample can identify the bacteria and determine its sensitivity to anti- TB drugs. This is crucial for selecting the appropriate treatment.
• Histopathological Examination: Examination of the biopsy tissue under a microscope can reveal granulomatous inflammation typical of TB.
• Sputum Smear and Culture: If there is evidence of pulmonary TB, sputum samples may be tested to identify the presence of TB bacteria.

Note: A comprehensive diagnostic approach ensures accurate identification of spinal TB and helps guide effective treatment planning.

to manage symptoms and prevent complications. Here’s an overview of the treatment approach:

• Antitubercular Medications: The most common treatment for spinal TB comprises first-line anti-TB drugs. The typical course of treatment lasts for 6 to 12 months, depending on the severity of the disease and response to therapy. The standard regimen often includes:
  Isoniazid (INH) Rifampicin (RIF) Ethambutol (EMB) Pyrazinamide (PZA)
• Surgical Intervention: Surgery may be required in cases with severe spinal deformities, significant spinal cord compression, or abscess formation that does not respond to medical treatment alone. Surgical options may include debridement of infected tissue, spinal stabilisation, or decompression of the spinal cord, with the choice of procedure depending on the extent and location of the disease.
• Supportive Care:
  Pain Management: Analgesics and anti-inflammatory medications can help manage pain and discomfort. Physical Therapy: Rehabilitation through physical therapy can improve mobility, strengthen the spine, and prevent further complications. Orthotic Support: Braces or supports may be used to stabilise the spine and correct deformities.