Potts Spine

[kames]

Hello Doctor,

I have been diagnosed for Potts spine last march (2007). I was recommended "AKT-4" (medicine 1 morning+2 afternoon+1 night) treatment course. After 2 months of medication MRI was taken and it showed further destruction of spine in L3-L4 region and elevated ESR of 116mm/hr. My medicine was changed to "4D plus" (1 morning+2 afternoon+1 night) and after 2 weeks ESR level was down  to 96mm/hr and bone showed slight improvement. There was collection of abscess in left psoas which was aspirated.

I continued the above treatment and my ESR level reduced to 80mm/hr. Further MRI + blood test in Aug'07 revealed that L2 region also got affected and my ESR level started to rise again.

Looking at above as per doctors advise, I underwent surgery in Aug'07 to drain out abscess and also bone/tissue sample of affected region was sent for biopsy which revealed that TB was sensitive to rifampicin, ethambutol, isoniazid and streptomycin. Accordingly, I was administered streptomycin injection (1 gm) for 100 days along with the above medicines (i.e. rifampicin 600mg, ethambutol 800mg, isoniazid 450mg, pyrizinamide 1500mg).

As follow up, I underwent another MRI in Jan'08 which revealed that the spinal bone in the affected region L2-L3-L4 region improved vis-a-vis Aug'07 MRI image but there was still some amount of abscess collection. My ESR level during the past 11 months were going up and down and now reads at 58mm/hr after a low of 40mm/hr during previous month. After the surgery, the surgical wound was draining puss (white liquid) and did not heal for 5 months (i.e.till Jan'08). I am still taking the above medicines except for streptomycin.

I request to kindly advise me on further course of action.

Regards,
kames

[kames]

With regards to previous posts, I am still on 4 drug AKT treatment. Recently about 3 weeks back I noticed lump formation to the left side of the left psoas region. Also there was small lump formation in the left hip. It was small in begining and now it grew into quite big lump. If u press with ur fingers, both the lumps are hard. The botton lump in the hip region is prominent and one can visually see the bulge.

Kindly advise.

[JainMD]

Hi,
The pain in hip region can be due to local irritation or nerve compression. ESR is indeed a vague indicator but when you were started on ATT if this report was taken then ESR can be used as prognostic indicator.
I am writing this post to express that I have gone through such a long post. I really appreciate that you were expressive enough to make anybody understand your condition.
Keep me posted if you have any queries.
Bye.

[kames]

Hello Dr. Jain,

At outset I thank you for taking your time out for me. I would also like to add further clarity to my previous post.

I would like to mention that my L2-L3-L4 region of my spine is affected only on the left side. As mentioned earlier I underwent biopsy surgery in August'07 and the TB culture test showed sensitive to streptomycin, rifampicin, ethambutol, isoniazid. I am taking the above medicines in dosages as mentioned in my previous post except for streptomycin injection. I have been under bed rest for past 10 months and has recently joined duty (away from my home town) this month on advise of my doctor. I am 35 years of age and I work in construction company as engineer, but I have stopped all site related work and I am only into desk job for now.

During the past 11 months I have been taking ESR, X-ray, CBP (complete blood picture) periodically in 3~5 week duration. I have been taking MRI @ 3~4months duration i.e. March'07, May'07, August'07, January'08. The MRI report of January'08 vis-a-vis August'07 report indicated improvement of bone in affected region and significant reduction in spinal stenosis. The CBP picture is normal throughout this entire 11 month period but only the ESR is going up and down. It was 58mm/hr  during last week of January'08 vis-a-vis 40mm/hr during December'07. X-ray shows slight improvement over pervious month's x-ray.

Last week I travelled a lot for 3 days and felt pain in the hip region and also on right side of my right leg near the hip region. I called my doctor and he said the pain is due to travel and advised me some pain killers. I did not take pain killers but took rest for 3 days and the pain got reduced. However, I feel pain in hip and also if I sit up & get up. If I walk a few steps the pain is reduced/gone. My doctor says the bone has not hardened/set completely and that's the reason the pain occurs.

As per my doctor my condition is improving gradually (i.e. comparatively slow pace). There is little swelling in left psoas, that's remained the same size since last few months.As given in my previous post my surgical wound was oozing puss (white fluid) and has now has completely healed after 5 months (i.e. in Jan'08). As per doctor, the healing of surgical wound indicates that the puss generation inside is subsiding and would stop in due course. Also the x-ray report shows slight improvement over previous month's x-ray report. My concern is that if ESR level raises again is there any reason to worry. My doctor says ESR factor is only a vague indicator. Also is there any other reason for pain in hip region.

I am sorry if I had written quite long post and repeated previous post.

Kindly advise.

I would be going for CBP/ESR/X-ray during 1st/2nd week of March'08.

Regards,
Kames

[JainMD]

Hi,
I am sure you know enough of TB spine till now as you have gone through almost all stages of Pott's spine.
I feel the further course of action should be to monitor your abcess, if increased further then you need to drain it and send for culture and sensitivity.
Look for ATT which are sensitive and accordingly if required change ATT.
Also monitor your ESR and Complete blood count regularly.
Imaging study on periodic basis is important to see the status of spine and also for prognostication.
Keep me posted if you have any queries.
Bye.