Spinal Condition
Spinal Tuberculosis (Pott's Disease) Treatment
TB of the Spine — Diagnosis & Surgical Management
Spinal tuberculosis (Pott's disease) — the most common form of musculoskeletal TB — accounts for up to 50% of all skeletal TB cases in India and requires early diagnosis to prevent irreversible neurological damage.
Understanding Spinal Tuberculosis
Mycobacterium tuberculosis reaches the spine haematogenously, typically affecting the anterior vertebral body. Progressive bone destruction leads to vertebral collapse, kyphotic deformity (gibbus), and paravertebral abscess formation. Cord compression from abscess, granulation tissue, or bony collapse produces Pott's paraplegia — the most feared complication. With early diagnosis and a full course of anti-tubercular therapy (ATT), most cases resolve without surgery. Surgical intervention is indicated for neurological deficit, progressive deformity, large abscess, or diagnostic uncertainty. Dr. Sparsh Jaiswal performs minimally invasive debridement and stabilisation, minimising blood loss while achieving radical clearance of diseased tissue.
infoCommon Causes
- Haematogenous spread of Mycobacterium tuberculosis to the vertebral body
- Close contact with active pulmonary TB
- Immunocompromised states — HIV, diabetes, malnutrition, steroid use
- Reactivation of latent TB during periods of immune suppression
symptomsKey Symptoms
- check_circleInsidious onset back pain — often worse at night
- check_circleConstitutional symptoms — low-grade fever, night sweats, weight loss, fatigue
- check_circleVisible spinal deformity (gibbus/angular kyphosis)
- check_circleParavertebral or psoas abscess causing swelling
- check_circleWeakness or paralysis of the lower limbs (Pott's paraplegia)
- check_circleBladder and bowel dysfunction in advanced disease
Diagnosis
MRI with contrast is the most sensitive investigation. CT-guided biopsy or open biopsy confirms microbiological diagnosis. ESR, CRP, Mantoux test, and IGRA support clinical diagnosis. Chest X-ray and CT chest assess pulmonary involvement.
verified_userMedically reviewed: May 2026 — Dr. Sparsh Jaiswal, MBBS DNB FISS FINM MNAMS · Apollo Hospitals, Indore (Reg: MP-16286 | MCI-19-30548)
Frequently Asked Questions about Spinal Tuberculosis
How common is spinal tuberculosis in India?
India accounts for approximately 26% of the global TB burden. Spinal tuberculosis (Pott's disease) represents up to 50% of all skeletal TB cases in India — making it far more prevalent here than in Western countries. It primarily affects the thoracic and thoracolumbar spine (lower chest and upper lumbar levels) and is most common in patients between 20–40 years of age, though all age groups are susceptible.
Can spinal TB be treated with medicines alone?
Yes — the majority of spinal TB cases respond to a full course of anti-tubercular therapy (ATT) lasting 12–18 months. The standard regimen combines isoniazid, rifampicin, ethambutol, and pyrazinamide. Surgery is reserved for cases with progressive neurological deficit, extensive abscess not resolving on ATT, severe spinal deformity, or diagnostic uncertainty requiring biopsy.
What is Pott's paraplegia?
Pott's paraplegia is the most severe complication of spinal TB — occurring when the spinal cord is compressed by abscess, granulation tissue, or bony collapse. It causes progressive weakness and numbness in the legs and, in severe cases, loss of bladder and bowel control. Early diagnosis and treatment of spinal TB is essential to prevent this complication. Neurological recovery is possible with timely surgical decompression.
What surgery is performed for spinal tuberculosis?
When surgery is required, Dr. Sparsh Jaiswal performs minimally invasive anterior debridement — removing infected bone and abscess through small incisions — combined with posterior percutaneous pedicle screw fixation to stabilise the spine. This achieves radical clearance of diseased tissue with significantly less blood loss than traditional open surgery, allowing patients to start early mobilisation and complete their ATT course without surgical complications.
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