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Bone/Spin TB

I was experiencing severe back pain since April 13 consulted few ortho but the disease was not diagnosed. In Aug 13 when the MRI was done then it came out that there was pus and on the basis of AFB report the doc started the treatment for BONE TB. The doctor also conducted CT guided biopsy (FNAC) and several other tests were done, I have pasted the MRI report and the test details of the ESR, AFB and Pus culture and Sensitivity.

As per doctors instruction another MRI was again conducted in Oct but there is an increase in pus. I would request you to look into the matter and suggest your opinion on whether the treatment prescribed by the doc is on right tract or not.  Also currently I have been advised bed rest for 2 months.

Given below are the details about my medicines and the tests conducted....

MRI Report details on Aug 13 - MR imaging of the lumbo-sacral spine was performed and high-resolution T1 and T2 weighted serial sections"obtained in the sagittal and axial planes and T2 STIR in sagittal plane using a phased Array surface coil on a 3-Tesla Scanner.
Observations:
The study shows normal curvature and alignment of the spine.
Diffuse marrow edema body of D10 vertebra with well-defined focal T1W hypointense and T2W hyperintense lesion along left side body of D10 along anterior superior part.
Left paravertebral T2 hyperintense and T1W hypointense collection at D8, D9 and D10 levels.
Focal signal changes along D9-10 intervertebral disc.
Rest of the lumbar vertebrae are normal.
Rest of the intervertebral discs are normal.
There is no evidence of any cord/ neural compression / canal stenosis.
Signals from the cord, conus medullaris and nerve roots forming the cauda equina are normal.
IMPRESSION: Marrow edema with focal lesion anterior superior part body of D10 vertebrae with left
paravertebral collection likely infective etiology. Differential diagnosis includes Tubercular osteitis
with left paravertebral abscess."

CT Guided was performed and following tests were done -
ESR - 5
AFB - +VE 2
PUS CULTURE & SENSITIVITY -STERILE AFTER 48 HRS UNDER 37 DEGREE CENTIGRADE
Medicine – till Oct 12 - AKT4 and Pyridoxine – 40 mg

MRI - Oct 13 - "MR imaging of the lumbosacral spine was performed and high-resolution T1 and T2 weighted serial sections
obtained in the sagittal and axial planes and T2 STIR in sagittal plane using a phased Array surface coil
on a 3-Tesla Scanner.
Observations:
Marrow edema with well-defined focal T1W hypointense and T2W hyperintense lesions are noted involving D8,
D9, D10 vertebrae along left side.
Left paravertebral T2 hyperintense and T1 hypointense collection is noted at D8, D9 and D10 levels.
Disc space between D9-10 is reduced with altered signal intensity within.
T2 hyperintense and T1 hypointense collection is also noted extending into epidural space at D9-10 level
compressing the thecal sac. However, signals from cord appear normal.
IMPRESSION: In a follow up case of Pott's spine.
Marrow edema with focal lesions are involving D8, D9, D10 vertebrae with left paravertebral collection and
epidural collection.
In comparison with previous scan done on 6-8-13, there is progression of disease with epidural abscess
formation."

Medicine -   In addition to above mentioned medicine he added Ofloxin and the same is to be taken twice a day  
1 Responses
144586 tn?1284669764
Tuberculosis is a nasty disease that has been around for thousands of years. Contrary to popular belief, the bacteria can colonize anywhere in the body, and not just the lungs. Once colonized they become encapsulated in biofilms and can never be completely eradicated. In 1945 Rutgers University developed the first antibiotic effective against TB, erythromycin, however since that time several drug resistant strains have developed. The best course of action is to follow the treatment protocol religiously, without missing a single dose of medications, and continue for as long as necessary. The drugs are often punishing with side effects, but you must take them. Surgical debridement is not always possible when the spine is involved. The United States Database "Pubmed" evaluates several protocols for treatment. There are different strains that respond to different treatments.
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