Spinal TB is a very dangerous type of skeletal TB as it can be associated with neurologic deficit due to compression of adjacent neural structures and significant spinal deformity. Therefore, early diagnosis and management of spinal TB has special importance in preventing these serious complications.
Dr Benjamin Adenitiri, a Rheumatologist and Consultant Physician based in Canada, says certain conditions and risk factors can predispose people to spinal Tuberculosis (TB).
On Tuesday in Abuja, he said that although TB of the lungs was more common, TB of the spine was equally a cause for concern.
He listed factors like malnutrition, chronic peritoneal dialysis, alcoholism, drug abuse, diabetes mellitus, immunosuppressive treatment, previous TB infection and HIV infection as predisposing conditions.
He said that it had disastrous and often irreversible complications.
The rheumatologist, who added that TB could affect several tissues outside the lungs, including the spine, said “for example, TB of the spine may give you back pain, and TB in your kidneys might cause blood in your urine.
“Spinal TB is caused by Mycobacterium tuberculosis bacteria, which spreads to the cancellous bone of the vertebral bodies via the bloodstream.
“The infection spreads to the adjacent vertebral bodies under the longitudinal ligaments. The primary infection site could be pulmonary or extrapulmonary such as lymph nodes, gastrointestinal or any other viscera.”
Adenitiri said that the initial symptoms were relatively nonspecific and common to any tubercular infection such as low-grade fever
with an evening rise, malaise, night sweats, anorexia and weight loss.
He noted that the confirmation of the diagnosis could be obtained by microbiological culture or histological analysis.
The expert added that radiological findings provide more useful information and they generally occur late.
He said that people living with AIDS were more at risk, adding that while the risk of TB was low, it was still something to watch out for.
“When this disease is diagnosed, it can be treated with a regimen of medications, and in more severe cases, medications can be used in addition to surgical intervention.
“TB chemotherapy plays a main role in treatment if the lesions are without complications and limited to the vertebrae,” he advised.
Adenitiri noted that the aim of the surgical treatment was to achieve an abscess debridement, spinal cord decompression, spinal stabilisation and prevent deformity.
For medical therapy, he said, the treatment of choice in patients without the neurologic deficit and surgical intervention may be needed in relatively few cases.
“In patients with neurologic complications, medical therapy is the first choice, but surgical treatments can be associated when indicated and yield the best results,” he said.
He announced that the outcome of spine TB had improved significantly by effective medical and surgical management even in the presence of neurologic deficits and spinal deformities.