Spinal tuberculosis is tuberculosis that occurs outside the lungs, precisely in the spine.This disease generally infects the spine in the middle area of the back.
Tuberculosis or tuberculosis (TB) of the spine is also known as Pott's disease. This condition can occur in someone who has or is suffering from pulmonary TB. However, in some cases, spinal tuberculosis can also occur in someone who has no previous history of TB.
Worldwide, spinal tuberculosis accounts for 10–35% of TB cases outside the lungs. This condition is classified as dangerous, because it can cause severe damage to the spine and spinal cord. As a result, sufferers can experience paralysis or even death.
Causes of spinal tuberculosis
Spinal tuberculosis occurs when bacteria Mycobacterium tuberculosis from the lungs or other locations outside the spine spread to the spine through the blood. These bacteria then attack the plates or joints between the vertebrae, causing the death of joint tissue and damage to the spine.
Spinal tuberculosis can occur in people who do not suffer from or have a history of tuberculosis in other organs. This is because the tuberculosis bacteria can be in the body without causing symptoms. This condition is also known as latent TB.
Tuberculosis transmission generally occurs through saliva splashes of pulmonary tuberculosis sufferers who sneeze or cough. Therefore, a person will be more at risk of contracting spinal tuberculosis if they often interact with TB sufferers.
Patients with spinal tuberculosis who do not have pulmonary TB cannot transmit this disease through the air. However, spread can occur if a person is exposed to blood or pus from the patient's wound.
There are several factors that can increase a person's risk of being infected with spinal tuberculosis, namely:
- Living in a slum and congested area
- Living in an area with a high rate of tuberculosis cases
- Interacting with people who are at high risk for TB infection
- old age
- Suffering from conditions that cause a decreased immune system, such as HIV/AIDS, cancer, advanced kidney disease, and diabetes
- Undergoing medication that causes a weakened immune system, such as chemotherapy, organ transplants, and immunosuppressant therapy
- Suffering from alcohol addiction or using illegal drugs
- Caring for patients suffering from TB infection
Symptoms of spinal tuberculosis
The presence of spinal tuberculosis is difficult to detect, because symptoms generally will only appear after the infection is severe enough or reaches an advanced stage. Sometimes, symptoms can also go unnoticed.
Patients with spinal tuberculosis usually experience the following symptoms:
- Back pain that is centered in one area and gets worse over time
- Stiffness in the back
- Lump or swelling on the back
- Humpback (kyphosis)
Spinal tuberculosis can also be accompanied by general symptoms of tuberculosis, such as:
- Fatigue
- Fever
- A cold sweat
- Loss of appetite
- Weight loss
Because spinal tuberculosis can be accompanied by pulmonary TB, pulmonary TB symptoms such as coughing and shortness of breath can also occur.
If spinal tuberculosis is severe enough, more serious symptoms will arise, such as:
- Difficulty moving or walking, especially in children
- Short limbs in children
- Nerve disorders, such as muscle weakness or paralysis, numbness from the waist down, stinging and radiating pain, and cauda equina syndrome
- Spinal deformities
- Headache, neck stiffness, fever, due to the spread of tuberculosis to the lining of the brain
Although rare, spinal tuberculosis can also occur in the neck and cause symptoms such as difficulty swallowing (dysphagia), hoarseness (stridor), torticollis, and muscle weakness or numbness in the hands and feet.
When to go to the doctor
Check with your doctor if you experience any of the symptoms listed above, especially if you have a history of tuberculosis or are suspected to have been exposed to tuberculosis from someone else. Although these symptoms are not necessarily caused by spinal tuberculosis, an examination to a doctor is necessary to confirm the diagnosis.
If you have risk factors for spinal tuberculosis, it is advisable to get screened by a doctor. It aims to detect the presence of latent TB in the body.
Spinal tuberculosis diagnosis
To diagnose tuberculosis, the doctor will ask questions related to the symptoms experienced. The doctor will also ask the patient's and family's medical history, to find out possible risk factors for spinal tuberculosis.
After that, a thorough physical examination will be carried out, which includes weighing, measuring body temperature and blood pressure, examining the heart and lungs, examining the lymph nodes, and examining the spine.
In order to confirm the diagnosis of spinal tuberculosis, investigations will be carried out to detect the presence of a bacterial infection Mycobacterium tuberculosis. Some of these checks are:
- Bacterial culture, by examining blood or sputum samples
- Biopsy, by taking a sample of infected tissue
- Scans with X-rays, CT scans, or MRIs, to detect problems in the spine
- Body fluid tests to check for infection, by taking joint fluid or pleural fluid (in the lungs) and cerebrospinal fluid (in the brain and spine), if tuberculosis is also suspected in these locations
- PCR test (polymerase chain reaction), to detect the genetic material of the bacteria that causes tuberculosis
- Immunological tests, to detect antibodies against the bacteria that cause tuberculosis by taking samples of the patient's blood or body fluids
Tuberculosis needs to be treated thoroughly so that co-morbidities that often accompany tuberculosis also need to be detected. Therefore, patients may also undergo screening to detect HIV/AIDS or diabetes.
Spinal TB Treatment
Spinal tuberculosis can generally be cured completely with proper treatment and as early as possible. On the other hand, this condition can be fatal if left untreated.
Spinal tuberculosis treatment aims to eliminate the tuberculosis infection and restore the damage that has occurred to the spine. The following are some of the treatment methods that can be used to treat spinal tuberculosis:
Drugs
Bacterial infections that cause spinal tuberculosis can be treated with antibiotics belonging to antituberculosis drugs (OAT). Treatment with OAT can last for 9–12 months.
The types of antibiotics that are most often used as antituberculosis drugs include:
- Rifampicin
- isoniazid
- Ethambutol
- Pyrazinamide
The above treatment must be carried out according to the rules given by the doctor. Keep in mind, antibiotics should be spent even if the patient experiences improvement in symptoms in the first few months. With good medication adherence, the chance of recovery for spinal tuberculosis patients is quite good.
On the other hand, taking drugs inappropriately or stopping treatment prematurely can cause bacteria to become resistant (resistant) to the drug. As a result, the disease can progress to become more severe and more difficult to treat.
In cases of drug-resistant spinal tuberculosis, the above combination of drugs can no longer be used. Treatment needs to be done with stronger antibiotics, such as levofloxacin, protionamide, amikacin, or streptomycin.
The drugs above can be given in the form of oral (drink) or injection (injection), and is done every day. In resistant spinal tuberculosis, the duration of drug administration can be longer, which is at least 20 months.
In addition to giving antituberculosis drugs, doctors can also give corticosteroids. These drugs aim to reduce inflammation, relieve symptoms, and prevent complications.
Use of assistive devices
In addition to medication, the patient will also be advised to wear a cast or spinal brace (spinal brace). The goal is to limit the movement of the patient's body. Usually, assistive devices are used during the first 2-3 months of treatment or until the spine stabilizes.
Operation
In severe cases, surgical procedures may be necessary, especially if:
- There are neurological disorders, such as paralysis or muscle weakness
- The shape of the spine has changed greatly and causes pain
- Treatment with drugs does not give a good response
The surgical procedure is performed by removing the damaged part of the spine (laminectomy).
Complications of spinal tuberculosis
Spinal tuberculosis can cause several complications, namely:
- Spinal damage that continues to get worse until it ends with the fusion of the vertebrae with each other
- Spinal cord injuries that cause permanent neurological disorders, such as muscle weakness or even paralysis
- Liver failure or kidney failure
- An abscess that can spread to the muscles around the spine, or even further into the thigh area and cause an open wound
- Spread of infection to the lining of the brain which can cause meningitis, or to the lining of the heart which can increase the risk of death
Prevention of spinal tuberculosis
Similar to the treatment of tuberculosis, vaccination is the main method for preventing spinal tuberculosis. The accepted vaccine is a vaccine Bacillus Calmette-Guerrin or BCG. However, please note that this vaccine is more effective when given to infants than in adults.
In addition, preventing HIV/AIDS can also reduce the risk of developing spinal tuberculosis. This is because spinal tuberculosis is more prone to occur in people with HIV/AIDS.
If you have active (symptomatic) pulmonary tuberculosis, there are several steps you can take to prevent transmission to others, namely:
- Take medication regularly according to the rules directed by the doctor.
- Stay home for the first few weeks of treatment, but reduce contact with householders.
- Cover your mouth or wear a mask when meeting other people or in public.
- Dispose of the tissue used for removing phlegm by first placing it in a plastic bag.
- Make sure the house has good air circulation in order to expedite the change of air in the house.
- Avoid too much interaction and crowding with other people.