Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentPrognosis
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Prognosis
This article discusses spinal tuberculosis—symptoms, causes, diagnosis, treatment, and prognosis for this condition.
x-reflexnaja / Getty Images
Symptoms of Spinal Tuberculosis
Spinal tuberculosis typically affects thethoracicspinein the upper back and thelumbar spinein the lower back.Symptoms of spinal tuberculosis are vague, particularly early on. They include:
As the disease progresses, symptoms can become more apparent, causing:
Spinal tuberculosis can put pressure on the spinal cord and nerves that exit the spine, causing neurological symptoms such as weakness in the legs, numbness, tingling, or even paralysis.
Only around 1 in 3 people who have bone tuberculosis (including spinal TB) will have typicalsymptoms of TB, including:
Stages of Bone TuberculosisTuberculosis in the bones (including the spine) often progresses in the following stages:Synovitis: Night pain and muscle spasmsEarly arthritis: Joint pain, muscle spasms, some effect on daily functionLate arthritis: Increased pain and spasms, decreased function, over 75% loss of range of motionAdvanced arthritis with subluxation and dislocation: Deformity of the involved joints, severely reduced range of motionTerminal arthritis: Joint becomes “fused” and no longer moves
Stages of Bone Tuberculosis
Tuberculosis in the bones (including the spine) often progresses in the following stages:Synovitis: Night pain and muscle spasmsEarly arthritis: Joint pain, muscle spasms, some effect on daily functionLate arthritis: Increased pain and spasms, decreased function, over 75% loss of range of motionAdvanced arthritis with subluxation and dislocation: Deformity of the involved joints, severely reduced range of motionTerminal arthritis: Joint becomes “fused” and no longer moves
Tuberculosis in the bones (including the spine) often progresses in the following stages:
What Causes Spinal Tuberculosis?
Spinal tuberculosis occurs whenM. tuberculosisinfects bones in the spine, calledvertebrae. This bacterium spreads from person to person through the air. Tuberculosis in the lungs is very contagious, but tuberculosis in other areas of the body—including the spine—is not typically contagious.Once it passes from an infected person to another, it can spread from the lungs to other body parts, including the spine.
What Is Tuberculosis?
Diagnosis of Spinal Tuberculosis
Spinal tuberculosis is not very common, and diagnosis is often delayed. Tuberculosis that affects the bones and joints (including the spine) occurs in around 1% to 3% of people with TB.
In addition, symptoms of spinal TB are similar to other, more common, conditions that causeback pain and stiffness, such as arthritis or a muscle strain—and people with spinal tuberculosis rarely have the lung infection that most commonly occurs with tuberculosis.
Symptoms of Spinal Arthritis
Skin and Blood Tests
The presence ofM. tuberculosisin the body can be detected with skin or blood tests.
If a firm, swollen bump develops, it is measured in millimeters. A positive result is a bump that measures 5 millimeters or more for a person who has recently been exposed to another person with TB.
Blood tests can also be performed to detect the presence of TB bacteria. Neither the skin nor blood tests specifically diagnose spinal tuberculosis—they only signify whether or not the bacteria is present.
A tissue acid-fast bacilli culture test is ideal for spinal tuberculosis, but it can be difficult to obtain a sample. In addition, results are often unavailable for six or more weeks, which could delay necessary treatment.
While many people exposed toM. tuberculosiswon’t have any symptoms, some may have a latent TB infection that may develop into active TB. Testing for latent TB is recommended for anyone at greater risk of exposure.
Imaging
Imaging is an important part of diagnosing spinal tuberculosis.
X-raystypically show decreased height of the vertebrae, bone erosion, rounding of the spine, and masses growing next to the spine.Magnetic resonance imaging (MRI)can show swelling in the bone marrow, abscesses in the bone, and narrowing of the spinal canal (space around the spinal cord).
How Is Spinal Tuberculosis Treated?
Treatment for spinal tuberculosis involves a combination of medications and other interventions, depending on the severity of damage that has occurred.
Medications
Medications used in the four-month protocol include:
Medications used in the six- or nine-month “RIPE” protocol include:
Drug-Resistant TB
Surgery
Spinal tuberculosis often requires surgery as part of treatment. The exact procedures used depend on the extent of bone damage.
Surgery can include cleaning out infected tissues (called debridement), removing eroded bone, placing screws and rods to stabilize the spine, or fusing vertebrae together.
Surgery can also involve bone grafting—taking a piece of bone from one place in the body and grafting it into the spine.
Prognosis for Spinal Tuberculosis
Spinal tuberculosis that isn’t treated can be fatal. Early detection is key for improved prognosis. Unfortunately, diagnosis of spinal TB is often delayed until the spine is deformed.While treatment takes many months, people can recover from spinal tuberculosis with medication and surgery.
Summary
Tuberculosis is a bacterial infection that usually affects the lungs. However, it can spread to other parts of the body, including the spine. Spinal tuberculosis can be difficult to diagnose—early symptoms include stiffness, back pain, and muscle spasms, which occur with other, more common back injuries.
Spinal tuberculosis is diagnosed with skin or blood tests, tissue cultures, and imaging. Treatment includes medication and, often, surgery to treat spine damage. Early diagnosis and treatment are essential for a favorable prognosis.
A Word From Verywell
Spinal tuberculosis is a serious disease. Talk to your healthcare provider if you have persistent back pain—particularly without an injury. Imaging can provide important information about the underlying cause of your symptoms. If you’ve been exposed to someone with TB, seek immediate medical attention.
12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Wang Y, Wang Q, Zhu R, et al.Trends of spinal tuberculosis research (1994–2015).Medicine (Baltimore). 2016;95(38):e4923. doi:10.1097/MD.0000000000004923Tom J, Hines A, Lazarescu R.Pott’s disease: a rare but critical diagnosis.CHEST. 2018;154(4):141A. doi:10.1016/j.chest.2018.08.122Agashe VM, Johari AN, Shah M, et al.Diagnosis of osteoarticular tuberculosis: perceptions, protocols, practices, and priorities in the endemic and non-endemic areas of the world—a waiot view.Microorganisms. 2020;8(9):1312. doi:10.3390/microorganisms8091312Abbas A, Rizvi SRH, Mahesri M, et al.Conservative management of spinal tuberculosis: initial series from pakistan.Asian Spine J. 2013;7(2):73-80. doi:10.4184/asj.2013.7.2.73Centers for Disease Control and Prevention.Tuberculosis: causes and how it spreads.Centers for Disease Control and Prevention.Clinical testing guidance for tuberculosis: tuberculin skin test.Finniss MC, Lewis P, Patel P.The use of pleural adenosine deaminase in the early diagnosis and treatment of spinal tuberculosis.Cureus. 2022;14(3):e23668. doi:10.7759/cureus.23668US Preventive Services Task Force, Mangione CM, Barry MJ, et al.Screening for Latent Tuberculosis Infection in Adults: US Preventive Services Task Force Recommendation Statement.JAMA. 2023;329(17):1487-1494. doi:10.1001/jama.2023.4899Centers for Disease Control and Prevention.Treatment for TB disease.Centers for Disease Control and Prevention.Clinical overview of drug-resistant tuberculosis disease.Kelly A, Younus A, Lekgwara P.Minimally invasive spinal surgery in spinal tuberculosis – a case report series.Interdisciplinary Neurosurgery. 2021;23:101010. doi:10.1016/j.inat.2020.101010Rasouli MR, Mirkoohi M, Vaccaro AR, et al.Spinal tuberculosis: diagnosis and management.Asian Spine J. 2012;6(4):294-308. doi:10.4184/asj.2012.6.4.294
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Wang Y, Wang Q, Zhu R, et al.Trends of spinal tuberculosis research (1994–2015).Medicine (Baltimore). 2016;95(38):e4923. doi:10.1097/MD.0000000000004923Tom J, Hines A, Lazarescu R.Pott’s disease: a rare but critical diagnosis.CHEST. 2018;154(4):141A. doi:10.1016/j.chest.2018.08.122Agashe VM, Johari AN, Shah M, et al.Diagnosis of osteoarticular tuberculosis: perceptions, protocols, practices, and priorities in the endemic and non-endemic areas of the world—a waiot view.Microorganisms. 2020;8(9):1312. doi:10.3390/microorganisms8091312Abbas A, Rizvi SRH, Mahesri M, et al.Conservative management of spinal tuberculosis: initial series from pakistan.Asian Spine J. 2013;7(2):73-80. doi:10.4184/asj.2013.7.2.73Centers for Disease Control and Prevention.Tuberculosis: causes and how it spreads.Centers for Disease Control and Prevention.Clinical testing guidance for tuberculosis: tuberculin skin test.Finniss MC, Lewis P, Patel P.The use of pleural adenosine deaminase in the early diagnosis and treatment of spinal tuberculosis.Cureus. 2022;14(3):e23668. doi:10.7759/cureus.23668US Preventive Services Task Force, Mangione CM, Barry MJ, et al.Screening for Latent Tuberculosis Infection in Adults: US Preventive Services Task Force Recommendation Statement.JAMA. 2023;329(17):1487-1494. doi:10.1001/jama.2023.4899Centers for Disease Control and Prevention.Treatment for TB disease.Centers for Disease Control and Prevention.Clinical overview of drug-resistant tuberculosis disease.Kelly A, Younus A, Lekgwara P.Minimally invasive spinal surgery in spinal tuberculosis – a case report series.Interdisciplinary Neurosurgery. 2021;23:101010. doi:10.1016/j.inat.2020.101010Rasouli MR, Mirkoohi M, Vaccaro AR, et al.Spinal tuberculosis: diagnosis and management.Asian Spine J. 2012;6(4):294-308. doi:10.4184/asj.2012.6.4.294
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Wang Y, Wang Q, Zhu R, et al.Trends of spinal tuberculosis research (1994–2015).Medicine (Baltimore). 2016;95(38):e4923. doi:10.1097/MD.0000000000004923Tom J, Hines A, Lazarescu R.Pott’s disease: a rare but critical diagnosis.CHEST. 2018;154(4):141A. doi:10.1016/j.chest.2018.08.122Agashe VM, Johari AN, Shah M, et al.Diagnosis of osteoarticular tuberculosis: perceptions, protocols, practices, and priorities in the endemic and non-endemic areas of the world—a waiot view.Microorganisms. 2020;8(9):1312. doi:10.3390/microorganisms8091312Abbas A, Rizvi SRH, Mahesri M, et al.Conservative management of spinal tuberculosis: initial series from pakistan.Asian Spine J. 2013;7(2):73-80. doi:10.4184/asj.2013.7.2.73Centers for Disease Control and Prevention.Tuberculosis: causes and how it spreads.Centers for Disease Control and Prevention.Clinical testing guidance for tuberculosis: tuberculin skin test.Finniss MC, Lewis P, Patel P.The use of pleural adenosine deaminase in the early diagnosis and treatment of spinal tuberculosis.Cureus. 2022;14(3):e23668. doi:10.7759/cureus.23668US Preventive Services Task Force, Mangione CM, Barry MJ, et al.Screening for Latent Tuberculosis Infection in Adults: US Preventive Services Task Force Recommendation Statement.JAMA. 2023;329(17):1487-1494. doi:10.1001/jama.2023.4899Centers for Disease Control and Prevention.Treatment for TB disease.Centers for Disease Control and Prevention.Clinical overview of drug-resistant tuberculosis disease.Kelly A, Younus A, Lekgwara P.Minimally invasive spinal surgery in spinal tuberculosis – a case report series.Interdisciplinary Neurosurgery. 2021;23:101010. doi:10.1016/j.inat.2020.101010Rasouli MR, Mirkoohi M, Vaccaro AR, et al.Spinal tuberculosis: diagnosis and management.Asian Spine J. 2012;6(4):294-308. doi:10.4184/asj.2012.6.4.294
Wang Y, Wang Q, Zhu R, et al.Trends of spinal tuberculosis research (1994–2015).Medicine (Baltimore). 2016;95(38):e4923. doi:10.1097/MD.0000000000004923
Tom J, Hines A, Lazarescu R.Pott’s disease: a rare but critical diagnosis.CHEST. 2018;154(4):141A. doi:10.1016/j.chest.2018.08.122
Agashe VM, Johari AN, Shah M, et al.Diagnosis of osteoarticular tuberculosis: perceptions, protocols, practices, and priorities in the endemic and non-endemic areas of the world—a waiot view.Microorganisms. 2020;8(9):1312. doi:10.3390/microorganisms8091312
Abbas A, Rizvi SRH, Mahesri M, et al.Conservative management of spinal tuberculosis: initial series from pakistan.Asian Spine J. 2013;7(2):73-80. doi:10.4184/asj.2013.7.2.73
Centers for Disease Control and Prevention.Tuberculosis: causes and how it spreads.
Centers for Disease Control and Prevention.Clinical testing guidance for tuberculosis: tuberculin skin test.
Finniss MC, Lewis P, Patel P.The use of pleural adenosine deaminase in the early diagnosis and treatment of spinal tuberculosis.Cureus. 2022;14(3):e23668. doi:10.7759/cureus.23668
US Preventive Services Task Force, Mangione CM, Barry MJ, et al.Screening for Latent Tuberculosis Infection in Adults: US Preventive Services Task Force Recommendation Statement.JAMA. 2023;329(17):1487-1494. doi:10.1001/jama.2023.4899
Centers for Disease Control and Prevention.Treatment for TB disease.
Centers for Disease Control and Prevention.Clinical overview of drug-resistant tuberculosis disease.
Kelly A, Younus A, Lekgwara P.Minimally invasive spinal surgery in spinal tuberculosis – a case report series.Interdisciplinary Neurosurgery. 2021;23:101010. doi:10.1016/j.inat.2020.101010
Rasouli MR, Mirkoohi M, Vaccaro AR, et al.Spinal tuberculosis: diagnosis and management.Asian Spine J. 2012;6(4):294-308. doi:10.4184/asj.2012.6.4.294
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
