Tuberculous spondylitis is a TB infection that affects the spine. It may cause back pain and, in severe cases, deformity or neurological issues.

Tuberculous spondylitis is a tuberculosis (TB) infection of the spine. Other terms for tuberculous spondylitis include spinal TB or Pott disease.

Tuberculous spondylitis may cause back pain and other symptoms of TB. Treatments may include medications to destroy TB bacteria and surgery to correct spinal issues.

This article examines the symptoms, causes, diagnosis, treatment, and outlook for tuberculous spondylitis.

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Tuberculosis spondylitis is a type of TB that affects the spine. It is a type of extrapulmonary TB, which occurs if a TB infection spreads outside of the lungs to other areas of the body.

TB mainly affects the lungs, which doctors refer to as pulmonary TB. Extrapulmonary TB accounts for around 15–20% of all instances of TB.

Tuberculous spondylitis is the most common type of TB affecting the musculoskeletal system. Spinal TB may only occur in around 1–2% of all people with TB.

Tuberculosis spondylitis usually causes back pain, which may sometimes radiate down the legs. People may also experience symptoms of TB, such as:

In people with severe cases, symptoms may also include:

  • deformity of the spine
  • instability
  • neurological deficits, such as changes in sensation or motor function

Tuberculous spondylitis occurs due to an infection with the Mycobacterium tuberculosis bacteria.

The bacteria can pass from one person to another if a person with an active TB infection spreads droplets in the air, such as through sneezing or coughing.

Prolonged exposure to people with an active TB infection may increase the risk of people contracting TB.

People with a weakened immune system have a higher risk of TB. This may include people with HIV, people who misuse alcohol or drugs, or those taking medications to suppress the immune system.

Other risk factors for TB include:

  • overcrowding, as this can cause it to spread easily
  • poverty, as people are more likely to live in overcrowded, poorly ventilated environments
  • malnutrition
  • a lower socio-economic situation

The TB bacteria thrive in oxygen-rich environments and can spread through the bloodstream from the lungs to reach the spine.

To diagnose tuberculous spondylitis, a doctor may conduct tests to check for TB infection and get imaging scans to examine the spine.

Tests for TB may include a skin test and blood tests. The tuberculosis skin test is an injection of fluid called tuberculin into the skin of the arm.

People wait 48–72 hours to see if there is a reaction on the arm. The TB skin test indicates that the person has been exposed to TB but does not differentiate past from current infection.

Blood tests, or interferon-gamma release assays (IGRAs), can also show whether a person has a TB infection present.

To check if TB is affecting the spine, a doctor may use:

Tuberculous spondylitis most commonly affects the thoracic spine, the middle part of the spine.

The main treatment for spinal TB is chemotherapy. Treatment with multiple drugs is essential in treating any drug-resistant bacteria.

People may need to continue treatment for 6 months or more. Some recommendations include a regime of 9–12 months. The regime may include months of taking four or five different drugs, such as:

  • isoniazid
  • rifampicin
  • pyrazinamide
  • ethambutol
  • streptomycin

People follow this up with a period of taking two drugs, such as isoniazid and rifampicin.

If first-line medications are not effective, other drugs may include:

  • kanamycin
  • capreomycin
  • amikacin

Some people may also require additional surgery if:

  • chemotherapy is not effective
  • tuberculous spondylitis is recurrent
  • neurological issues are severe
  • there is deformity or instability
  • there is severe pain

Depending on the severity of the condition, surgery may aim to:

  • drain any abscesses
  • remove any infected tissue
  • stabilize the vertebrae
  • correct any deformity

Early diagnosis and treatment can help achieve a positive outcome with tuberculous spondylitis.

The outlook may depend on the severity of the condition and symptoms. Tuberculous spondylitis with complications, such as deformity, instability, and neurological deficits, may have a less positive outlook.

Other factors affecting outlook can include a person’s age, overall health, immune system health, and response to drug therapies.

Minimally invasive surgery may provide excellent outcomes for tuberculous spondylitis.

Tuberculous spondylitis is a type of TB that affects the spine. People may experience back pain and other symptoms of TB infection, such as fatigue, fever, weight loss, and appetite loss.

Treatments for tuberculous spondylitis may include multi-drug treatments and, for some people, surgery.