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Spinal tuberculosis or tuberculosis (TB) is also known as Pott's disease, which is tuberculosis that occurs outside the lungs, where it affects the spine. This disease generally infects the spine in the lower thoracic (chest) area and upper lumbar vertebra (waist).
Causes of Spinal TB
Tuberculosis is caused by a bacterium called mycobacterium tuberculosis. This bacterium spreads through the splashing of saliva in tuberculosis patients who sneeze or cough. The longer or more often someone interacts with TB patients, the greater the risk of contracting this disease.
Spinal tuberculosis results from the spread of tuberculosis bacteria from the lungs to the spine to the joints between the spine. This condition causes the death of joint tissue and triggers damage to the spine. Some other risk factors that cause a person to become infected with spinal tuberculosis include:
- Low or bad socioeconomic factors influence the quality of life standards, for example people who live in dense and crowded areas.
- Living in an area that has high or endemic cases of tuberculosis.
- People who lack nutrition.
- Elderly people.
- HIV infection which results in a low immune system.
- People with other declining immune systems, such as people with cancer, advanced stage kidney disease, and diabetes.
- Alcoholics or drug users.
- People who are at risk for tuberculosis and spinal tuberculosis must recognize the symptoms well in order to help ease the diagnosis after testing.
Symptoms of Spinal TB
Like tuberculosis, the presence of spinal tuberculosis is difficult to detect. In general, patients experience chronic back pain that has no known cause. Therefore, doctors have difficulty diagnosing. This condition can last around four months.
In addition to the common symptoms of tuberculosis, spinal tuberculosis also has additional symptoms that may be felt by some sufferers, including:
- Attacks or symptoms that appear gradually.
- Fever.
- Sweating at night.
- Losing weight.
- Anorexia (eating disorder) that triggers weight loss.
- Localized back pain.
- Having an upright and stiff body position.
- The curved spine comes out causing the back to become bent (kyphosis).
- Swelling of the spine.
- A groin lump appears that resembles a hernia.
- When it comes to the nervous system, it is likely that there will be a nervous breakdown that affects the organs of the body.
- The diagnosis of spinal tuberculosis in children requires a high index of suspicion.
Diagnosis of Spinal TB
Examination will begin with a history of the symptoms experienced, a history of diseases that have been suffered and family history. Then a physical examination will be carried out in the form of:
- Check the arrangement of the spine
- Detailed examination of nerve function
- Evaluate the presence or absence of subcutaneous lumps in the stomach area
- Examination of the skin is included in the hollow area.
Then there will be a laboratory test to confirm the diagnosis. Some laboratory tests that may be performed to obtain a diagnosis of spinal tuberculosis are:
- Red blood cell sedimentation tests are carried out to detect if there is inflammation in the body.
- The Mantoux skin test is carried out to ascertain and determine whether the patient is infected with TB bacteria or not, based on the skin reaction that has been injected with tuberculin PPD.
- MRI and CT scans are performed to determine the degree of suppression and changes in bone elements in the early stages of the disease. However, MRI is recommended more than CT scans.
- Spine and chest X-ray (CXR). This test is done to detect if there is damage or narrowing of space between the spinal pieces. In addition, this procedure can find out if there is tuberculosis in the respiratory tract that spreads to the spine.
- Biopsy of bone or synovial tissue using a needle may also be carried out to detect bacteria that cause spinal tuberculosis. Possible bacterial culture is needed to confirm the diagnosis.
Careful and thorough examination is important to do in an effort to distinguish the diagnosis of spinal tuberculosis from other conditions that have similar symptoms, such as:
- Spinal tumor
- Multiple myeloma
- Other cancer metastases.
Treatment of Spinal TB
Slightly different from the condition of tuberculosis, treatment of spinal tuberculosis is likely to require surgery as a form of additional treatment other than the antibiotics given to treat tuberculosis. Patients with spinal tuberculosis may also be advised not to move their spine for a certain period. This is done by wearing special shoes or tools for a long time. In addition, a series of physical therapies will be recommended to be followed in order to reduce pain and exercise bone strength and flexibility.
In the treatment of spinal tuberculosis, administration of antibiotics is still carried out until the specified treatment period and must be spent. Some types of antibiotics are commonly used, including rifampicin and ethambutol. Possible side effects of these drugs include jaundice, fever, rash, itching, decreased appetite and dark urine. Painkillers may be prescribed by a doctor too. Therapy for spinal tuberculosis treatment can last up to more than six months, depending on the severity and physical condition of the patient.
Although the healing period can last for months to years, spinal tuberculosis can still be cured as long as it can immediately be detected and handled properly. Another goal of this rapid treatment is to reduce the risk of patients getting complications, in the form of various types of abnormalities or defects in the spine to experience paralysis.
Prevention of Spinal TB
Similar to the steps to treat tuberculosis, vaccination is the main preventive measure for spinal tuberculosis. The vaccine received is Bacillus Calmette-Guerrin or BCG vaccine. This vaccine must be given before the baby is three months old. Children, adolescents, and adults who have not received the BCG vaccine are also advised to receive this vaccine as soon as possible even though it will affect the decrease in the level of effectiveness. Other important spinal tuberculosis prevention measures are:
- Cover your mouth or wear a mask when in a public place when sneezing, coughing, or laughing.
- For non-sufferers, wear a mask if you interact with TB patients. Also avoid interacting too often with sufferers.
- Begin the habit of washing your hands regularly.
- Make sure the house has good air circulation in order to launch air changes in the house.
