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pott's spine
My son,aged 27,is under ATT forthe last 4 months as he has diagnosed with infection/ganulation formation at L5-S1.The pain has reduced to a great extent.Now,he is on R-cinex 600 and mycobutol 1200. Please suggest if any he can do any exercise for the back.Any other suggestion for speedy recovery.The period for which medication is likely to continue may also be advised.
Hi Surjit,
How is your son? What have the doctor said? Pott's disease often involves two or more adjacent vertebral bodies.
What level is the spinal cord affected?
It is more common for lower thoracic and upper lumbar vertebrae to be affected in adults.
I don't think it is a nice idea to go for exercise when you are having Pott’s disease.
I think he should be completely the course of treatment and get a repeat imaging done to evaluate the spine.
Was there an abcess formation? If yes, was it aspirated and sent for culture?
What did the doctor say about the source of infection?
What method has he planned for follow up? Was a culture being taken? If so, was it positive?
New smear or culture positive cases, the duration of treatment is 6 months which includes 2 months of intensive therapy and 4 months of continuation phase.
I would be interested to know about his disease progression and treatment.
Bye.
How is your son? What have the doctor said? Pott's disease often involves two or more adjacent vertebral bodies.
What level is the spinal cord affected?
It is more common for lower thoracic and upper lumbar vertebrae to be affected in adults.
I don't think it is a nice idea to go for exercise when you are having Pott’s disease.
I think he should be completely the course of treatment and get a repeat imaging done to evaluate the spine.
Was there an abcess formation? If yes, was it aspirated and sent for culture?
What did the doctor say about the source of infection?
What method has he planned for follow up? Was a culture being taken? If so, was it positive?
New smear or culture positive cases, the duration of treatment is 6 months which includes 2 months of intensive therapy and 4 months of continuation phase.
I would be interested to know about his disease progression and treatment.
Bye.
Respected Sir,
Thanx for your kind response.
The investigation of MRI Lumbo-sacral spine revealed as under:
'"Signal alteration and enhanement of L5 & S1 vertebrae and part of posterior arch,sacral ala and pre,para sacral and right paraspinal muscle collection with extra-dural granulation tissue and right neural foramina collection at L5-S1 level.Findings are suggestive of pott'''s spine."'
The following medicines were given for the first 3 months:
R-cinex 600
Mycobutol 1200
PZA 1500
The PZA has been discontinued after 3 months.Now,R-cinex 600 & mycobutol 1200 is being given.
The pain is cured,but when the sitting is of longer duration,slight pain is felt .
The abcess/lump has disappeared.No,culture was taken out.
Further.valuable consultation is solicited.
Thanx for your kind response.
The investigation of MRI Lumbo-sacral spine revealed as under:
'"Signal alteration and enhanement of L5 & S1 vertebrae and part of posterior arch,sacral ala and pre,para sacral and right paraspinal muscle collection with extra-dural granulation tissue and right neural foramina collection at L5-S1 level.Findings are suggestive of pott'''s spine."'
The following medicines were given for the first 3 months:
R-cinex 600
Mycobutol 1200
PZA 1500
The PZA has been discontinued after 3 months.Now,R-cinex 600 & mycobutol 1200 is being given.
The pain is cured,but when the sitting is of longer duration,slight pain is felt .
The abcess/lump has disappeared.No,culture was taken out.
Further.valuable consultation is solicited.
Hi Surjit,
This confirms the diagnosis of Pott’s spine and also that it is at lower back (area where it is common in adults).
Pain after sitting for longer duration may be due nerve compression.
How long they want to continue R-cinex and Mycobutol?
Is your son also on Vitamin B6 supplements?
You need to do a repeat a scan to see healing at the lower back.
Keep me informed.
Bye.
This confirms the diagnosis of Pott’s spine and also that it is at lower back (area where it is common in adults).
Pain after sitting for longer duration may be due nerve compression.
How long they want to continue R-cinex and Mycobutol?
Is your son also on Vitamin B6 supplements?
You need to do a repeat a scan to see healing at the lower back.
Keep me informed.
Bye.
Respected Doctor,
A bundle of thanx for your quick and solicited response.
A second MRI was done after 2 months from the start of ATT which reads as under:
: "Folllow-up case of caries spine showing signal alteration in body and right transverse process of L5 vertibra, S1 vertebral body and right sacral ala along with mild pre/right paraspinal soft tissue showing extension into right erector spinae muscles & overlying subcutaneous tissue. Mild soft tissue/granulation issue is noted in right neural foramen and right lateral recess at L5-S1 level with mild impression on right traversing nerve route. Comparison with previous MRI dated 18-08-2007 shows improvement and significant reduction in pre/right paraspinal soft tissue."
It is pertinent yo mention that second MRI is dated 30/10/2007.
-The medication i.e R-cinex & Mycobutol is likely to be continued upto the period of 6 months from the start of ATT.
-Vitamin B6 supplements are also being given.
Please advise if the pain can be attributed to resistance of the present medicine regime as one of the consultant has recommended to substitute Mycobutol 1200 with Oflox 800.
Your valuable advice & guidance is further solicited.
With Regards,
surjit singh
A bundle of thanx for your quick and solicited response.
A second MRI was done after 2 months from the start of ATT which reads as under:
: "Folllow-up case of caries spine showing signal alteration in body and right transverse process of L5 vertibra, S1 vertebral body and right sacral ala along with mild pre/right paraspinal soft tissue showing extension into right erector spinae muscles & overlying subcutaneous tissue. Mild soft tissue/granulation issue is noted in right neural foramen and right lateral recess at L5-S1 level with mild impression on right traversing nerve route. Comparison with previous MRI dated 18-08-2007 shows improvement and significant reduction in pre/right paraspinal soft tissue."
It is pertinent yo mention that second MRI is dated 30/10/2007.
-The medication i.e R-cinex & Mycobutol is likely to be continued upto the period of 6 months from the start of ATT.
-Vitamin B6 supplements are also being given.
Please advise if the pain can be attributed to resistance of the present medicine regime as one of the consultant has recommended to substitute Mycobutol 1200 with Oflox 800.
Your valuable advice & guidance is further solicited.
With Regards,
surjit singh
Hi Surjit,
I have not heard of back pain being attributed to resistance to Mycobutol.
The common side effects of Ethambutol (active ingredient of Mycobutol) are visual disturbance, color blindness, skin rash, fever, confusion, headache, nausea, loss of appetite, abdominal pain, vomiting.
If a MRI which was done in 30/10/2007 shows improvement, where is the evidence of resistance of drugs?
How is his weight gain? Is he feeling feverish again? Does he have similar back pain what he used to have earlier? Is he not interested in taking his meals?
I think we should be doing a repeat MRI scan to assess amount of granulation tissue present.
Keep me informed.
Bye.
I have not heard of back pain being attributed to resistance to Mycobutol.
The common side effects of Ethambutol (active ingredient of Mycobutol) are visual disturbance, color blindness, skin rash, fever, confusion, headache, nausea, loss of appetite, abdominal pain, vomiting.
If a MRI which was done in 30/10/2007 shows improvement, where is the evidence of resistance of drugs?
How is his weight gain? Is he feeling feverish again? Does he have similar back pain what he used to have earlier? Is he not interested in taking his meals?
I think we should be doing a repeat MRI scan to assess amount of granulation tissue present.
Keep me informed.
Bye.
Resoected Doctor,
Thanx for your kind response.
My son has gained weight about 4-5 kg during the period of medication.He has no fever.He now does not feel morbid pain as he felt earlier . He has no loss of appetite and takes his meals regularly.However,recently he was having feeling of headache,nausea & vomiting.But after taking metrogyl 400 (twice a day for 5 days ) & domstar as well as Siazole tablets,he is feeling better.He is taking Liv52 since the begining of the treatment.
Please advise if it is the right time to repeat MRI scan or we should wait for some more time.Further,please advise if Vitamins B6 supplements have any side effects.
With Regards,
surjit singh
Thanx for your kind response.
My son has gained weight about 4-5 kg during the period of medication.He has no fever.He now does not feel morbid pain as he felt earlier . He has no loss of appetite and takes his meals regularly.However,recently he was having feeling of headache,nausea & vomiting.But after taking metrogyl 400 (twice a day for 5 days ) & domstar as well as Siazole tablets,he is feeling better.He is taking Liv52 since the begining of the treatment.
Please advise if it is the right time to repeat MRI scan or we should wait for some more time.Further,please advise if Vitamins B6 supplements have any side effects.
With Regards,
surjit singh
Hi Surjit,
I feel if there is any consensus of changing the medicines it should be done after looking at the current MRI scan as this was basis to start treatment and also basis to say that he was doing well.
You need to discuss this with your son's physician and decide regarding further management.
As far as Vitamin B6 supplements are concerned they are supposed to be continued.
Increase in dosage of Vitamin B6 can also cause headaches, nausea and vomiting.
I think his treatment is going on fine and we can wait and see for any new symptom development.
Keep me informed about the decision of treating doctor.
Bye.
I feel if there is any consensus of changing the medicines it should be done after looking at the current MRI scan as this was basis to start treatment and also basis to say that he was doing well.
You need to discuss this with your son's physician and decide regarding further management.
As far as Vitamin B6 supplements are concerned they are supposed to be continued.
Increase in dosage of Vitamin B6 can also cause headaches, nausea and vomiting.
I think his treatment is going on fine and we can wait and see for any new symptom development.
Keep me informed about the decision of treating doctor.
Bye.
Dear Doctor,
Please advise the B6 supplements which do not have animal extact/rennet and are useful in treatment of pott's spine.Also,please clarify if increase uric acid level can also attribute to ocassional pain in the lower back at L5-S1.Can uric acid be controlled without medicines?Is it true that anti -tuber drugs elevate the uric acid level.
Is it advisable for the patient to resort to morning and evening walks? can light/yogic exercises meant for spine be undertaken?
Any other remedial/preventive measures may kindly be advised.
With Regards,
surjit singh
Please advise the B6 supplements which do not have animal extact/rennet and are useful in treatment of pott's spine.Also,please clarify if increase uric acid level can also attribute to ocassional pain in the lower back at L5-S1.Can uric acid be controlled without medicines?Is it true that anti -tuber drugs elevate the uric acid level.
Is it advisable for the patient to resort to morning and evening walks? can light/yogic exercises meant for spine be undertaken?
Any other remedial/preventive measures may kindly be advised.
With Regards,
surjit singh
Hi Surjit,
I am sorry to say that I am not aware of any vitamin B6 supplement free of animal extract.
Uric acid elevation can be due to renal failure or any medications which has decreased renal clearance.
High protein and weight reduction diet can also cause high uric acid.
Hyperuricemia can present with pain, but mostly in joints.
Yes he can do early morning and evening walks.
He can also try yoga and light exercises.
Keep me informed.
Bye.
I am sorry to say that I am not aware of any vitamin B6 supplement free of animal extract.
Uric acid elevation can be due to renal failure or any medications which has decreased renal clearance.
High protein and weight reduction diet can also cause high uric acid.
Hyperuricemia can present with pain, but mostly in joints.
Yes he can do early morning and evening walks.
He can also try yoga and light exercises.
Keep me informed.
Bye.
Hello Doctor,
My father, aged 62 yrs has been a diabetic for 12 years now. Last month, we visited an orthopedic surgeon since my father was complaining of back pain for about 3-4 months. On getting an x-ray, doctor suspected Spinal TB and recommended MRI. The MRI report confirmed Pott's Spine. Here's the extract of the MRI report:
Findings: The study shows marginal erosions of D8, D9 and D10 verteberal bodies involving D9-D10 intervening disc abd anterior aspect of D8-9 disc with pre, para and epidural multi loculated abscess collection. The right para verteberal collection measures 7.9x2.2 cms and left para vertebral collection mesures 6.3x2.6 cms. The epidural collection at D8-9 and D9-10 causin moderatte impression on thecal sac and bilateral lateral nerve roots. There is also altered signal intensity of D9 and D10 pedicles.
There is erosion with enhancement of anterior aspect of D11 and S1 vertebral bodies with minimal adjacent anterior vertebral collectoins.
Intervertebral Discs: Disc dehydration is seen at all levels.
L4-5 : Posterior central and bilateral para central disc protrusion causing mild impression and thecal sac, bilateral pre foraminal exiting and foraminal traversing nerve roots.
IMPRESSION: MR features are suggestive of KOCH's involving multiple Dorso-Lumbar vertebral and D8-D9, D9-10 discs as described with pre, para and epidural multi loculated abscess collection at D8,D9, and D10 levels causing significant impression on thecal sac and bilateral nerve roots.
The doctor adviced following medication:
AKT 4. (a pack with 4 diff tabs, 1 in the morn, 2 a\n and 1 in the night)
Myoril for 7 days
Taylors Brace
Doctor was contemplating a surgery and after discussioin with the neuro surgeon, they decided against the surgery since my father was mobile and there was no pain or trouble in walking and started the ATT and mentioned that after 4-6 weeks, a second scan would be required to see the development and then take a call on Surgery.
Its has been close to 4 weeks now since he is on ATT and since last 2 weeks, he gets sudden attack of severe back pain in the night. On 3 instances we had to rush to casualty in the middle of the night and get a pain releiving injection (Inj INAC).
We visted the doc and he said tht the we had manage the pain with pain killers for the time being and wait to complete 4 weeks of medication, to see any developments. He is also mentioning that surgery can be done if we are in agreement.
Now we are worried about whether to go for surgery or continue the ATT medication especially due to the fact that the pain is severe when it occurs and wanted a second opinion.
- Is such frequent sudden attack of pain common during such a treatment? Because the pain is frequent and severe, I was wondering if the medication was correct.
- I heard spinal surgery is only the last resort and that surgery is required on critical conditions when the patient becomes immobile. Is it true? In that case, should we consider not opting for surgery considering, there is no immobility?
Please advice, and sorry for such a extended discription of the whole situation. Just wanted to make sure I have given all the possible information.
Thanks and regards
Ranga
My father, aged 62 yrs has been a diabetic for 12 years now. Last month, we visited an orthopedic surgeon since my father was complaining of back pain for about 3-4 months. On getting an x-ray, doctor suspected Spinal TB and recommended MRI. The MRI report confirmed Pott's Spine. Here's the extract of the MRI report:
Findings: The study shows marginal erosions of D8, D9 and D10 verteberal bodies involving D9-D10 intervening disc abd anterior aspect of D8-9 disc with pre, para and epidural multi loculated abscess collection. The right para verteberal collection measures 7.9x2.2 cms and left para vertebral collection mesures 6.3x2.6 cms. The epidural collection at D8-9 and D9-10 causin moderatte impression on thecal sac and bilateral lateral nerve roots. There is also altered signal intensity of D9 and D10 pedicles.
There is erosion with enhancement of anterior aspect of D11 and S1 vertebral bodies with minimal adjacent anterior vertebral collectoins.
Intervertebral Discs: Disc dehydration is seen at all levels.
L4-5 : Posterior central and bilateral para central disc protrusion causing mild impression and thecal sac, bilateral pre foraminal exiting and foraminal traversing nerve roots.
IMPRESSION: MR features are suggestive of KOCH's involving multiple Dorso-Lumbar vertebral and D8-D9, D9-10 discs as described with pre, para and epidural multi loculated abscess collection at D8,D9, and D10 levels causing significant impression on thecal sac and bilateral nerve roots.
The doctor adviced following medication:
AKT 4. (a pack with 4 diff tabs, 1 in the morn, 2 a\n and 1 in the night)
Myoril for 7 days
Taylors Brace
Doctor was contemplating a surgery and after discussioin with the neuro surgeon, they decided against the surgery since my father was mobile and there was no pain or trouble in walking and started the ATT and mentioned that after 4-6 weeks, a second scan would be required to see the development and then take a call on Surgery.
Its has been close to 4 weeks now since he is on ATT and since last 2 weeks, he gets sudden attack of severe back pain in the night. On 3 instances we had to rush to casualty in the middle of the night and get a pain releiving injection (Inj INAC).
We visted the doc and he said tht the we had manage the pain with pain killers for the time being and wait to complete 4 weeks of medication, to see any developments. He is also mentioning that surgery can be done if we are in agreement.
Now we are worried about whether to go for surgery or continue the ATT medication especially due to the fact that the pain is severe when it occurs and wanted a second opinion.
- Is such frequent sudden attack of pain common during such a treatment? Because the pain is frequent and severe, I was wondering if the medication was correct.
- I heard spinal surgery is only the last resort and that surgery is required on critical conditions when the patient becomes immobile. Is it true? In that case, should we consider not opting for surgery considering, there is no immobility?
Please advice, and sorry for such a extended discription of the whole situation. Just wanted to make sure I have given all the possible information.
Thanks and regards
Ranga
Hi,
How is your father?
I am feeling bad for your father as he has to go thru all this at this age.
Tuberculosis (TB) of the spine (Pott’s disease) is the most common site of bone infection in TB; hips and knees are also often affected. The lower thoracic and upper lumbar vertebrae are the areas of the spine most often affected.
Drug treatment is generally sufficient for Pott’s disease, with spinal immobilization if required. Surgery is required if there is spinal deformity or neurological signs of spinal cord compression.
The doctor is right in suggesting waiting for 4 weeks of medication, and a second scan would give a clear picture regarding surgery.
Yes, it is true that surgery is required on critical conditions.
Keep me informed.
Good luck.
Bye.
How is your father?
I am feeling bad for your father as he has to go thru all this at this age.
Tuberculosis (TB) of the spine (Pott’s disease) is the most common site of bone infection in TB; hips and knees are also often affected. The lower thoracic and upper lumbar vertebrae are the areas of the spine most often affected.
Drug treatment is generally sufficient for Pott’s disease, with spinal immobilization if required. Surgery is required if there is spinal deformity or neurological signs of spinal cord compression.
The doctor is right in suggesting waiting for 4 weeks of medication, and a second scan would give a clear picture regarding surgery.
Yes, it is true that surgery is required on critical conditions.
Keep me informed.
Good luck.
Bye.
Dear Doctor,
Thank you for such a quick response.
Just some more clarifications:
1. AKT 4 : I have heard from other people that they were adviced to take all 4 tabs in the strip together in the morning on empty stomach...however, we were adviced to take the red capsule in the morn, the 2 tabs in a\n and the other in the night. Is that the right way of dosage?
2. What could be cause of this sudden attack of pain? Is it common? My father was adviced of complete rest along with the taylors brace and he exactly doing that. With the start of medication, we were hoping the pain would reduce, but the pain is more sever than the past. Is pain killers the only solution for the time being?
Thanks again!
Regards
Ranga
Thank you for such a quick response.
Just some more clarifications:
1. AKT 4 : I have heard from other people that they were adviced to take all 4 tabs in the strip together in the morning on empty stomach...however, we were adviced to take the red capsule in the morn, the 2 tabs in a\n and the other in the night. Is that the right way of dosage?
2. What could be cause of this sudden attack of pain? Is it common? My father was adviced of complete rest along with the taylors brace and he exactly doing that. With the start of medication, we were hoping the pain would reduce, but the pain is more sever than the past. Is pain killers the only solution for the time being?
Thanks again!
Regards
Ranga
Hi,
I think the doctor is right in giving the drug in split dosages, but I have usually seen patient taking one in morning and others in afternoon before lunch.
The cause of sudden pain is due to reaction between the antibiotics and the organism at the back. This is causing pain and this will subside soon.
The pain will subside subsequently don't worry about it.
Keep me informed if you have any queries.
Bye.
I think the doctor is right in giving the drug in split dosages, but I have usually seen patient taking one in morning and others in afternoon before lunch.
The cause of sudden pain is due to reaction between the antibiotics and the organism at the back. This is causing pain and this will subside soon.
The pain will subside subsequently don't worry about it.
Keep me informed if you have any queries.
Bye.
Thanks great information!
Thank you so much. I really appreciate your help!
Could you please tell me where you are located?
Thanks and regards
Ranga
Thank you so much. I really appreciate your help!
Could you please tell me where you are located?
Thanks and regards
Ranga
Hi Ranga,
How is your father feeling?
I really feel nice that I could help you out and most of your doubts are cleared.
I am based in India and you too seem to sound like an Indian.
Which city are you from and which doctor are you consulting?
I am physician with specialization in child health too.
I would be interested to answer question on child health and dental.
Keep me informed if you have any queries.
Bye.
How is your father feeling?
I really feel nice that I could help you out and most of your doubts are cleared.
I am based in India and you too seem to sound like an Indian.
Which city are you from and which doctor are you consulting?
I am physician with specialization in child health too.
I would be interested to answer question on child health and dental.
Keep me informed if you have any queries.
Bye.
Hello Doctor,
I am from Bangalore and I am consulting Dr. HemaChandra Shetty (Orthopedic Surgeon) from Bangalore Hospital.
Where are you located in India? Do you pratice in a clinic or in a hospital?
Regards
Ranga
I am from Bangalore and I am consulting Dr. HemaChandra Shetty (Orthopedic Surgeon) from Bangalore Hospital.
Where are you located in India? Do you pratice in a clinic or in a hospital?
Regards
Ranga
Hi,
Currently I am based in Mumbai.
I have my clinic at Mumbai and attached to hospitals.
What about you, what are you basically?
Is there any body in family with history of chronic cough or any features of Tuberculosis?
How many family members are there in family? Any kid is there in family?
Currently I am based in Mumbai.
I have my clinic at Mumbai and attached to hospitals.
What about you, what are you basically?
Is there any body in family with history of chronic cough or any features of Tuberculosis?
How many family members are there in family? Any kid is there in family?
Hi,
I work for Hewlett Packard as an Asst Mgr.
I have 2 elder sisters who are married. So currently at home, its just my parents and I..
My eldest sis has a 5 yr old son...she was in UK during her early pregnancy and duing that time she was diagonised with Pulmonary TB..other than that no history of TB in the family...my father had dry cough for a long time before spinal TB was detected..now tht has stopped...
Regards
Ranga
I work for Hewlett Packard as an Asst Mgr.
I have 2 elder sisters who are married. So currently at home, its just my parents and I..
My eldest sis has a 5 yr old son...she was in UK during her early pregnancy and duing that time she was diagonised with Pulmonary TB..other than that no history of TB in the family...my father had dry cough for a long time before spinal TB was detected..now tht has stopped...
Regards
Ranga
Hi Ranga,
The reason I asked you about number of family members as every member of family should be screened for TB including the maid who comes to work.
If any kid is around then you should be screening that kid for TB.
Have you got yourself checked for TB?
Bye.
The reason I asked you about number of family members as every member of family should be screened for TB including the maid who comes to work.
If any kid is around then you should be screening that kid for TB.
Have you got yourself checked for TB?
Bye.
Hello Doctor
No, None of us have got ourselves screened for TB? Hows can Spinal TB be contegeous??...You are scaring me :(
Regards
Ranga
No, None of us have got ourselves screened for TB? Hows can Spinal TB be contegeous??...You are scaring me :(
Regards
Ranga
Hi Ranga,
I am sorry if you feel that I am scarring you. My intentions are clear to make sure that nobody else is affected.
You had mentioned earlier in one of your post that he is being having chronic cough for long.
If that's the case, you should be screening everybody in house.
I think the best way to do is to get you an x-ray chest done with tuberculin test.
Let me know where you are getting it done and what are the results.
If a newborn is around, then the baby needs to be started on ATT.
Bye.
I am sorry if you feel that I am scarring you. My intentions are clear to make sure that nobody else is affected.
You had mentioned earlier in one of your post that he is being having chronic cough for long.
If that's the case, you should be screening everybody in house.
I think the best way to do is to get you an x-ray chest done with tuberculin test.
Let me know where you are getting it done and what are the results.
If a newborn is around, then the baby needs to be started on ATT.
Bye.
Hi,
Yes, he was having dry cough for while..that has stopped now...I will get myself screened for TB...Thanks for that info!
Regards\
Ranga
Yes, he was having dry cough for while..that has stopped now...I will get myself screened for TB...Thanks for that info!
Regards\
Ranga
Hi,
Yes, he was having dry cough for while..that has stopped now...I will get myself screened for TB...Thanks for that info!
Regards\
Ranga
Yes, he was having dry cough for while..that has stopped now...I will get myself screened for TB...Thanks for that info!
Regards\
Ranga
Hi Ranga,
How are you? As a doctor it is our nature to inform patients regarding disease and its manifestations. I thought it was my duty to inform you about screening as TB is curable and preventable disease. The medicines nowadays have much less side effects than before.
Keep me informed if you have any other queries.
Bye.
How are you? As a doctor it is our nature to inform patients regarding disease and its manifestations. I thought it was my duty to inform you about screening as TB is curable and preventable disease. The medicines nowadays have much less side effects than before.
Keep me informed if you have any other queries.
Bye.
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