Sarcoidosis: Causes, Symptoms, Diagnosis & Treatment

Spinal Tuberculosis With Concomitant Spondylolisthesis: Coexisting ...

Study design:

Report of three unusual cases of coexisting spondylolisthesis and tuberculosis in the same patient.

Objectives:

To document the rare occurrence and attempt to postulate the probable reasons for such an association.

Setting:

Tertiary care teaching hospital in a developing country.

Methods:

This communication reports the outcome of three cases where there was spondylolisthesis and spinal tuberculosis in the same patient. The probable reason for such an occurrence is discussed along with a literature review relevant to this topic.

Results:

The cases responded favorably to conservative treatment with multidrug antitubercular chemotherapy and spinal braces.

Conclusions:

Association of spondylolisthesis and spinal tuberculosis is extremely rare. If the tubercular process is fulminant, spondylolisthesis secondary to destruction of posterior elements by the infective process can occur. Gross destruction of anterior elements secondary to tuberculosis in some patients may place excessive stresses on the posterior elements and may precipitate a spondylolisthesis even if there was no active infection in the posterior elements. However, there remains a distinct possibility that pars defect may have existed prior to infective pathology.

Spinal Tuberculosis Can Paralyze If Ignored - Times Of India

With two lakh patients in India and significant prevalence in Pune, disease is a cause for concern

PUNE: For 53-year-old Latabai (name changed), it started with tingling numbness in he legs, heaviness and stiffness of the calf muscle. Soon, a few hours of continuous sitting would aggravate the pain around her waist, resulting in loss of mobility. She could not sleep, sit and do household chores.Even after popping painkillers, undergoing physical exercises and postural changes for many days, the pain refused to subside. After three months, doctors asked her to undergo an MRI test,which revealed that she was suffering from tuberculosis of the spine known as Pott's spine or Pott's disease.Although tuberculosis of the lungs is more common, tuberculosis of the spine is equally a cause for concern, having disastrous and often irreversible complications, experts said. Nearly two lakh people in India suffer from tuberculosis of the spine, experts said. In Pune, the prevalence of spinal tuberculosis is equally high."I diagnose at least three patients every week with spine tuberculosis," said spine surgeon Ketan Khurjekar, head of spine surgery department at Sancheti Hospital. Nowadays, there is an increasing trend of spine tuberculosis in the country in view of irregular medical management, emergence of resistant strains and low immunity in patients to chemotherapy, steroids or surge in patients of HIV, he added. According to Khurjekar, medical faculty cannot escape from this condition as every year at least one medical student from a batch of 200 comes to him with Pott's spine.In 2009, among the 7,500 patients seen at spine department in Sancheti Hospital, 47 patients were diagnosed with spinal TB. Similarly, there were 98 patients with spinal TB in 2010 and 137 patients with spinal TB in 2011. Bone and joint tuberculosis accounts for up to 35% cases of extrapulmonary tuberculosis. Skeletal tuberculosis most often involves the spine, followed by tuberculous arthritis in weight-bearing joints and extraspinal tuberculous osteomyelitis, Khurjekar said. "The symptoms for spinal tuberculosis are localized back pain, painful movements, fever, a hump in the back, excessive weight loss, and in worst cases,weakness of hands or legs," said spine surgeon Rajesh Parasnis, head of spine surgery department at Oyster and Pearl Hospital. Mycobacterium tuberculosis invades the vertebral body causing an inflammatory reaction and then later progressing to destroy bones of the spine. Sometimes, there can be a visible appearance of a deformity of the back, Parasnis said.Spinal tuberculosis can result in the collapse of vertebrae and fracturing of the bones. Abscesses and tissue formation can narrow the spinal canal, leading to neurological damage. In advanced untreated cases, this can lead to compression of the spinal cord resulting in complete paralysis of both legs and rarely, upper limbs. "Once the patient reaches the stage of paralysis, even with good surgical treatment, the recovery may not always be possible," Parasnis said.Diagnosis of spinal tuberculosis is complex. In the early stages, MRI scans would detect the infection long before we see it on X-rays. Range of motion in the spine can be tested. Pathological / microbiological examination of affected tissue is the most definitive test, he added."Early diagnosis followed by prompt and adequate treatment can completely cure spinal tuberculosis. Treatment options include antibiotics and corrective spine surgeries. Advanced surgery procedures are quite safe and in a proper set-up have given excellent results consistently," Parasnis said.In neglected cases, patient may develop angular deformity due to destruction of vertebral bodies called as kyphosis. Blood test, x-rays, MRI scan and biopsy aid diagnosis. Treatment includes taking anti-tuberculosis medication religiously. Drugs are effective in control of disease. A brace is used to protect the spine during treatment period."Patients who do not respond to medical treatment and those who develop neurological deficit in spite of treatment need surgery. Surgery involves drainage of inflammation area and stabilization using bone graft or implants," Parasnis said. Persistent back pain present even during rest, fever and loss of appetite should alert one. Improper or inadequate treatment with medicines can aggravate the problem by creating drug-resistant bacteria which may be very difficult to treat.Early detection and prolonged treatment with appropriate drugs as per national guidelines, said experts.

Tuberculous Spondylitis: Symptoms, Causes, Treatment, Outlook - Healthline

Tuberculous spondylitis occurs when a tuberculous infection spreads to the spine. Bacterial damage to the spine can cause severe pain, abnormal back curvature, and paralysis. The condition is serious but treatable.

Tuberculous spondylitis is a rare but serious infection that is fatal without medical treatment.

Treatment first addresses the infection. Additional treatments can include attending to any underlying conditions that could be weakening your immune system, and surgery to correct any damage to the spine and backbone.

This article reviews symptoms, risk factors, diagnosis, treatment, and outlook for people with tuberculous spondylitis.

Tuberculous (TB) spondylitis is also called TB of the spine, spinal TB, and Pott's disease. The condition is caused by the same bacteria that cause tuberculosis.

It occurs when the bacteria travel to the spine and then invade the backbone. Over time, the disease can cause the bones to collapse, leading to spinal abnormalities and a curve in the back.

At first, tuberculous spondylitis causes the symptoms typically associated with TB, including:

Once the infection progresses to the spine, it can cause many additional symptoms. The full extent of symptoms can depend on how far the bacteria spread and on if the bacteria affect the nerves that run through the spinal cord.

severe back pain

reduced control over limb movement, especially in the legs

limb paralysis

abnormal spinal bending

sharp back curvature

Tuberculous spondylitis is caused by the same bacteria that cause TB: Mycobacterium tuberculosis. This bacterium is contagious and spreads among people who've been exposed.

You're more likely to experience severe complications of the bacteria, such as tuberculous spondylitis, if your immune system is weakened from any health conditions or medications. People with weakened immune systems are at higher risk in certain locations. This includes:

correctional facilities

homeless shelters

developing countries

Even for people with weakened immune systems, TB is rare in the United States.

The first step to diagnosing tuberculous spondylitis is a medical appointment. During your appointment, you and a doctor will discuss your symptoms and medical history.

They'll likely ask whether you've recently been in a part of the world where TB is more common. If your doctor suspects you have tuberculous spondylitis, they'll order a TB test. This test looks for infection with the TB bacteria.

There are two versions of the TB diagnostic test:

Purified protein derivative (PPD) test: A PPD test is a two-step TB test. You might have had this test in the past as part of a pre-employment physical or as one of the required steps before living in a college dorm. This test is done by injecting a protein under your skin that reacts to the TB bacteria and causes a visible bump at the injection sight if TB is present.

Blood testing: Blood tests can look for TB. This test is more expensive to do than a PPD test, but it is more often done for people who are suspected of having active TB infections.

Once TB is confirmed, your doctor will likely do additional testing to look for signs of tuberculous spondylitis. This typically includes imaging tests, such as X-rays and MRI.

These tests are done to look at your spine and check for degeneration or abnormalities. MRIs can also detect collections of bacteria in the spine, called epidural abscesses, that can occur with tuberculous spondylitis.

In some cases, you might also have a biopsy. Your doctor might order a biopsy if there is a mass in your spine that could be caused by tuberculous spondylitis or by another condition, such as spinal cancer.

Imaging can't always detect the difference, so a biopsy will be used to determine whether there are TB bacteria in your spine. During the biopsy, a small sample of the mass will be removed. It will then be tested in a lab for TB.

A treatment plan for tuberculous spondylitis typically has multiple parts. The first part is always treating the TB infection. For most people, TB is treated with a combination of medications taken over several months. TB medication often includes:

Ethambutol

Isoniazid

Pyrazinamide

Rifampin

Additional steps will depend on any co-occurring conditions and the extent of spinal damage. This can include treatment for conditions that might be weakening your immune system, such as HIV. Starting treatment for these conditions can help you reduce the risk of additional severe infections.

Spinal damage might need to be treated with surgery. Surgical options can help correct severe curvature and the decompression of the spinal cord. This can help relieve pressure on the nerves and reduce symptoms such as pain and limb paralysis.

Tuberculous spondylitis is a rare condition that occurs when tuberculous bacteria spread to the spine. The bacterial infection damages the spinal cord and the surrounding backbones. This can lead to severe pain, paralysis, weakness, and back curvature.

Tuberculous spondylitis is diagnosed through a standard TB test to identify the bacteria. Further diagnosis is made by imagining tests and biopsies to examine spine damage.

Treatment involves medication to resolve the TB infection, treatment of any underlying conditions, and surgery to correct spinal damage.

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