Tuberculosis of the Spine (Pott Disease)

What is this condition?

Spinal tuberculosis is infection of vertebrae and discs by Mycobacterium tuberculosis. It can destroy bone, form abscesses, produce kyphosis and compress the spinal cord or roots. Fever may be absent, so persistent focal pain in a TB-endemic region deserves thoughtful assessment rather than repeated painkillers alone.

What symptoms can it cause?

• Persistent local back pain and stiffness
• Weight loss, reduced appetite, night sweats or low fever may occur
• Limb weakness, numbness or walking difficulty from compression
• Visible deformity or a cold swelling/abscess

How is it assessed and diagnosed?

MRI shows marrow, disc, abscess and neural compression; CT defines bone destruction. ESR/CRP and chest/body assessment support evaluation. Whenever safely possible, image-guided or surgical tissue should be sent for histology, microscopy, culture and molecular drug-resistance testing because ordinary and drug-resistant TB require different regimens.

Treatment without surgery

Most neurologically stable patients are treated with a supervised multidrug anti-tuberculosis regimen under TB/infectious-disease care, with nutrition, pain treatment and selected bracing. The exact drugs and duration depend on susceptibility, national guidance, age, liver function and response; patients should not stop when pain improves.

When is surgery or a procedure considered?

Surgery is considered for progressive neurological deficit, severe cord compression, instability, major or worsening deformity, large abscess not responding, uncertain diagnosis or failure of appropriate medical treatment. Procedures include biopsy, abscess drainage, decompression, debridement and stabilisation. Implants can be used when necessary in an appropriately treated infected spine.

Treatment and procedure options

• Supervised multidrug anti-TB therapy
• Image-guided biopsy or drainage
• Surgical decompression and debridement
• Stabilisation and deformity management
• Long-term clinical, laboratory and imaging follow-up

Risks from the disease and from treatment

Untreated disease can cause paralysis, bladder loss, severe deformity, chronic pain and spread. Medication can affect liver and other organs; resistance can emerge with irregular therapy. Surgery risks are higher in severe destruction, but delay in progressive cord compression may be worse. No procedure is risk-free. General risks include anaesthetic problems, bleeding, infection, blood clots and delayed healing. Neurological risks depend strongly on the exact structure being treated and may include new weakness, numbness, speech or vision change, seizure, cerebrospinal-fluid leakage, need for another procedure or failure to obtain the hoped-for relief. The surgeon should discuss the risks that apply to the individual case.

Recovery and follow-up

Pain and inflammatory markers often improve before bone fully heals. Neurological recovery can take months. Adherence, nutrition and monitoring for drug toxicity are essential. Imaging changes can lag behind clinical improvement, so treatment is not stopped on one scan alone. Recovery is not judged only by the first few days. Pain control, wound care, nutrition, safe mobilisation, physiotherapy and planned follow-up all matter. Some symptoms improve quickly after pressure is relieved; others recover gradually over weeks or months, and permanent nerve injury may not fully reverse.

Preparing for your consultation

Bring the original MRI/CT images or digital files, written reports, previous prescriptions, a current medicine list, and any operative or pathology records. For sudden warning symptoms, use the nearest emergency department rather than waiting for a routine appointment.

Authoritative patient-information sources

• World Health Organization — Tuberculosis: https://www.who.int/health-topics/tuberculosis
• AANS — Spinal Infections: https://www.aans.org/patients/conditions-treatments/spinal-infections/