Dr Himanshu Tyagi, Senior consultant Spine & Orthopaedic surgeon.

Phone : 9654095717

MCh Orthopaedics (U.K), FNB Spine surgery, DNB Orthopaedics.


Spine is most commonly affected bone by tuberculosis infection. It primarily affects thoracic spine; however, tuberculosis of  lumbar spine, cervical spine and sacrum are not uncommon. Primary lesion in spine tuberculosis is infection of the disc and adjacent vertebral bones. This gradually involves vertebral bodies causing destruction and collapse of vertebra. Occasionally, infection starts in vertebral body or posterior part of bony vertebral ring. Spinal tuberculosis can also involve spinal cord and it’s coverings (Meninges).

Symptoms of Spine Tuberculosis:

Patients usually presents with pain at the site of infection. Typical symptoms of tuberculosis (fever, night sweat, loss of appetite, weight loss) are many times absent in spinal tuberculosis. If vertebral destruction is significant, patient may have localized deformity (kyphosis) at that level. In advance cases, patients may have symptoms of spinal cord compression (loss of sensation and weakness in arms/ legs, loss of bladder-bowel control, loss of dexterity and weakness in hand grip, loss of balance and spasticity in legs), which happens due to compression by:

Displaced bone fragments from vertebral body destruction and collapse,

Pus and granulation tissue in spinal canal,

Compression of spinal cord by deformed spine,

Direct involvement of spinal cord by infection

Diagnosis of Spine Tuberculosis:



MRI Scan: An MRI is usually done early in cases suspected to be having spinal tuberculosis. It will reveal infection affecting disc and adjacent vertebral bodies in detail. Vertebral body destruction, amount of spinal cord compression, presence of infection at other levels, infection inside the spinal cord will also be evident on an MRI. MRI is also done to assess patient’s response to treatment. Though spinal tuberculosis has typical MRI picture, it cannot confirm whether it is tuberculosis, or bacterial infection, or some other lesion. A biopsy is required for that.



Treatment of Spine Tuberculosis:

TB is a medical disease. Even if a surgery is done, it is absolutely must to take anti-tubercular drugs to eradicate TB infection. TB bacteria responds slowly to drugs, hence a long duration of treatment is required. This may range from 12 -24 months depending on the type of infection (resistant TB versus normal TB), response to drugs, site of infection etc. For patients who are diagnosed in early phase, and who do not have any indication for surgery (please see below), a medical treatment with appropriate drugs is usually sufficient. This should be accompanied by good nutrition, adequate rest, bracing of the affected spine segment, symptomatic treatment for pain and nutritional supplements. A close watch on patient’s response to drug therapy is necessary by clinical examination, blood tests and imaging to ensure gradual resolution of the patient’s symptoms/ progressive healing of the lesion and to catch any complication caused by medicines/ disease process to treat them early.

Surgery is required when patient presents with any of the followings, either at first presentation or during the course of medical treatment:

Signs of severe spinal cord compression (loss of sensation and weakness in arms/ legs, loss of bladder-bowel control, loss of dexterity and weakness in hand grip, loss of balance and spasticity in legs),

Progressive worsening of spinal cord compression symptoms during treatment,

X-ray/ MRI evidence of severe bone destruction which can cause spine instability, increased pain, deformity and spinal cord compression,

Severe pain not responding to medical treatment,

To obtain biopsy in difficult cases.

Usually a spine decompression and fusion surgery is required in these cases. Spine fusion will give pain relief, correct and prevent progression of spine deformity, allow adequate spinal decompression to take place and prevent recurrence of spinal stenosis, stabilize spine to help in infection healing, allow early mobilization and prevent need of bed rest after surgery. In rare instances, where vertebral destruction is not significant and primary symptoms are of spine stenosis, a decompression only procedure can be done. Also, a TB lesion inside the spinal cord might also need only decompression surgery if not responding to medical treatment/ and to confirm diagnosis.

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