Aa
pott spine/ spine tb
my son nikhil jindal aged 20 years had neck pain and stiffness abt a month back followed by fever (100 to 101.6) after 3-4 days of neck pain started.
on 26 mar he was put on topcef 200mg 2 tabs a day for 3 days all medicines were given to patient
on 27 mar his blood was tested and report was as under
TLC 12,600,
DLC- NEUTROPHILS 69.2, LYMPHOCYTES 21.3, MONOCYTES 7.8, EOSINOPHILS 1.1, BASOPHILS 0.6
ESR(WESTREGEN'S) 102
S.G.P.T.(A.L.T.) 31.23
WIDAL TEST WAS NEGATIVE
BASED ON ABOVE TESTS DOCTOR SUGGESTED FOR CHEST X RAY
0n 29 mar he was put on topcef 200mg tab mobizox for another 3 days all medicine wr given to patient
x ray report of chest was normal
but still fever (99 to 101) and pain continues
doctor suggested x ray cervical spine on 29 mar
report was as under
straightening of spine is seen with loss of normal curvature suggestive of muscle spasm
irregularity of articular surface of c5 seen
prevertebral soft tissue thickening is seen
cystic lesion seen anteriorly at body of c6
disc spaces are normal
no cervical rib is seen
ADVISED - MRI CERVICAL SPINE
DOCTOR REFERRED THE PATIENT TO ORTHOPEDIC BASED ON ABOVE REPORT
ortho doc put on the following treatment
inj monocef 1gm I.V - BD
inj Acenac MR 1 BD
these injections were injected for 5 days
doctor suggested for MRI cervical spine
report dated 05 apr his test report was as under
there is straightening of cervical spine
cervicodorsal vertebral bodies from c2 to d4 level reveal focal or diffuse marrow signal intensity alterations hypointense on T1W1 and hyperintense on STIR images, suggestive of marrow edema/inflation. marrow edema is most marked in c6 vertabral bodies.
large prevertabral abscess is seen in cirvicodosral region displaying hypo to isointense signals on T2W1. abscess is predominantly seen on the left side of midline involving preverbtal muscles with mild extensions on right side in right preverbtal muscles.
cranially it is extending upto c2 verteba and caudally till d4 in posterior aspect of superior mediastium. abscess is also seen to extending into left c5-6 and c6-7 neural foramina with mild posterolateral wall of oropharynx and upper esophagus.
CSF shows normal signal intensity. cord shows normal morphology and signal.
CV junction is normal.
IMPRESSION - MR imaging features aree suggeastive of infective spondylitis with large pre vertebal abscess from c2 to d4 and mild epidural extension at c6 level.
Etiology - likely tubercular
his blood test report dated 06 apr was as under
TLC 10,600
DLC- NEUTROPHILS 68.4, LYMPHOCYTES 22.1, MONOCYTES 7.6, EOSINOPHILS 1.4, BASOPHILS 0.5
ESR(WESTREGEN'S) 110
S.G.P.T.(A.L.T.) 48.57
TSH- 2.020
BASED ON ABOVE INVESTIGATIONS and his continue temp (99 to 100) and neck pain
doctor put him on
AKT 4 1 kit in morning
oflaxin 1 OD 400 mg
tab liv 52 2tabs BD
a second opinion was taken and it was suggested that patient is suffering from pott spine( cervical spine)
and he put on
AKT 4 daily for 1 month
tab pyridoxine 10 mg daily for 1 month
philadiflion collar(MGRM)
also complete bed rest was advised
the patient started taking AKT4 and pyridoxine from 06 apr as par above suggestion
another opinion was taken and it was suggested
to start phase I
rest in bed for 22 hrs for 1 and half month
tab Rcinex 300+600 mg daily in morning
tab oflox 400 mg daily in morning
shelcal-1
cobadex-1
ciplection 1
all above for 5 monthes
somi brace to be worn by pateint
kindly suggest if it is 100% sure that my son is infected with pott spine
or any other test is reqd to be done for confirmation
i want to give treatment after only 100% confirmation of the disease and not in doubt pls
how can it be confirmed
3 doctors have suggested 3 types of treatment although all 3 diagnosed same disease and other one suggested for COTS
sir, i m in total confusion
kindly advice which medicine is the best in india for pott spine
an advice from an expert doctor like u will be a real help to humankind
regards
10 apr 10
pawanj
on 26 mar he was put on topcef 200mg 2 tabs a day for 3 days all medicines were given to patient
on 27 mar his blood was tested and report was as under
TLC 12,600,
DLC- NEUTROPHILS 69.2, LYMPHOCYTES 21.3, MONOCYTES 7.8, EOSINOPHILS 1.1, BASOPHILS 0.6
ESR(WESTREGEN'S) 102
S.G.P.T.(A.L.T.) 31.23
WIDAL TEST WAS NEGATIVE
BASED ON ABOVE TESTS DOCTOR SUGGESTED FOR CHEST X RAY
0n 29 mar he was put on topcef 200mg tab mobizox for another 3 days all medicine wr given to patient
x ray report of chest was normal
but still fever (99 to 101) and pain continues
doctor suggested x ray cervical spine on 29 mar
report was as under
straightening of spine is seen with loss of normal curvature suggestive of muscle spasm
irregularity of articular surface of c5 seen
prevertebral soft tissue thickening is seen
cystic lesion seen anteriorly at body of c6
disc spaces are normal
no cervical rib is seen
ADVISED - MRI CERVICAL SPINE
DOCTOR REFERRED THE PATIENT TO ORTHOPEDIC BASED ON ABOVE REPORT
ortho doc put on the following treatment
inj monocef 1gm I.V - BD
inj Acenac MR 1 BD
these injections were injected for 5 days
doctor suggested for MRI cervical spine
report dated 05 apr his test report was as under
there is straightening of cervical spine
cervicodorsal vertebral bodies from c2 to d4 level reveal focal or diffuse marrow signal intensity alterations hypointense on T1W1 and hyperintense on STIR images, suggestive of marrow edema/inflation. marrow edema is most marked in c6 vertabral bodies.
large prevertabral abscess is seen in cirvicodosral region displaying hypo to isointense signals on T2W1. abscess is predominantly seen on the left side of midline involving preverbtal muscles with mild extensions on right side in right preverbtal muscles.
cranially it is extending upto c2 verteba and caudally till d4 in posterior aspect of superior mediastium. abscess is also seen to extending into left c5-6 and c6-7 neural foramina with mild posterolateral wall of oropharynx and upper esophagus.
CSF shows normal signal intensity. cord shows normal morphology and signal.
CV junction is normal.
IMPRESSION - MR imaging features aree suggeastive of infective spondylitis with large pre vertebal abscess from c2 to d4 and mild epidural extension at c6 level.
Etiology - likely tubercular
his blood test report dated 06 apr was as under
TLC 10,600
DLC- NEUTROPHILS 68.4, LYMPHOCYTES 22.1, MONOCYTES 7.6, EOSINOPHILS 1.4, BASOPHILS 0.5
ESR(WESTREGEN'S) 110
S.G.P.T.(A.L.T.) 48.57
TSH- 2.020
BASED ON ABOVE INVESTIGATIONS and his continue temp (99 to 100) and neck pain
doctor put him on
AKT 4 1 kit in morning
oflaxin 1 OD 400 mg
tab liv 52 2tabs BD
a second opinion was taken and it was suggested that patient is suffering from pott spine( cervical spine)
and he put on
AKT 4 daily for 1 month
tab pyridoxine 10 mg daily for 1 month
philadiflion collar(MGRM)
also complete bed rest was advised
the patient started taking AKT4 and pyridoxine from 06 apr as par above suggestion
another opinion was taken and it was suggested
to start phase I
rest in bed for 22 hrs for 1 and half month
tab Rcinex 300+600 mg daily in morning
tab oflox 400 mg daily in morning
shelcal-1
cobadex-1
ciplection 1
all above for 5 monthes
somi brace to be worn by pateint
kindly suggest if it is 100% sure that my son is infected with pott spine
or any other test is reqd to be done for confirmation
i want to give treatment after only 100% confirmation of the disease and not in doubt pls
how can it be confirmed
3 doctors have suggested 3 types of treatment although all 3 diagnosed same disease and other one suggested for COTS
sir, i m in total confusion
kindly advice which medicine is the best in india for pott spine
an advice from an expert doctor like u will be a real help to humankind
regards
10 apr 10
pawanj
Sir , after reading your advice to many patients I have been wanting to get my doubts cleared too.
Mty husband was diagnosed with spinal tb. The lesions were at L5,S1. It was extreme pain that drove us to hospital for MRI and other tests.
The MRI showed the TB problem and complete bed rest was ordered. with medicines for tb started 2 April.
We are continuing with the bed rest but could you tell me at what point should we get MRI done to monitor the treatment?
It is over 5 weeks now in bed. Should we start rehab execrises? He wants to start walking agin but is it too soon? Will it cause him any problems?
There is still pain in the legs.
Pregalin provides relief.
Will appreciate your considered opinion.
Mty husband was diagnosed with spinal tb. The lesions were at L5,S1. It was extreme pain that drove us to hospital for MRI and other tests.
The MRI showed the TB problem and complete bed rest was ordered. with medicines for tb started 2 April.
We are continuing with the bed rest but could you tell me at what point should we get MRI done to monitor the treatment?
It is over 5 weeks now in bed. Should we start rehab execrises? He wants to start walking agin but is it too soon? Will it cause him any problems?
There is still pain in the legs.
Pregalin provides relief.
Will appreciate your considered opinion.
hello sir, thanks for ur answer. now my pain 95percent cured. this month 22nd my tablet course will be changed by doctor. sir kindly tell me that what happen whn taking more calcium dose? becoz im take 'bio-D3 plus calcium capsule' how long may i use this?somewhere i hear that taking more calcium can cause kidny stones are formed is it true
MEDICAL PROFESSIONAL
Hello!
1) I have given the standardized doses for his weight but titration of doses should not be done by me or you but by the treating physician as he will understand the side effects of all these antibiotics and how Nikhil responds. As you have changed the doses, inform his doctor.
2) Always take him to an orthopedician consultancy after end of every month for first three months then after 2 months till the treatment is complete.
3) A total of 3 X-rays for a period of 6months-1yr is sufficient.
4) Only go for further tests if his treating physician wants.
5) DO NOT DISCONTINUE DRUGS. After 2 months of 4 drugs now he will need 2 drugs for further 6 months. Remember the treatment is for 6-9 months.
Take care!
1) I have given the standardized doses for his weight but titration of doses should not be done by me or you but by the treating physician as he will understand the side effects of all these antibiotics and how Nikhil responds. As you have changed the doses, inform his doctor.
2) Always take him to an orthopedician consultancy after end of every month for first three months then after 2 months till the treatment is complete.
3) A total of 3 X-rays for a period of 6months-1yr is sufficient.
4) Only go for further tests if his treating physician wants.
5) DO NOT DISCONTINUE DRUGS. After 2 months of 4 drugs now he will need 2 drugs for further 6 months. Remember the treatment is for 6-9 months.
Take care!
based on ur confirmation the dosage for more than 50kg body weight: i have changed the medicines of my son from AKT4 to Rcinex 600+300, pyrazinamide 1500mg, Ethambutol 800mg. as body wt of my son is 67 kg
is it ok?
now sud i consult ortho splst or TB specialist or medicine splst for his further treatment?
sud i also go for CPR test alongwith Xray?
pls also suggest if i can go for QuantiFERON®-TB Gold now as i came to know just now that this test is 100% confir test for TB? and if it is negative for TB can i discontinue the TB medicines at this stage?
is it ok?
now sud i consult ortho splst or TB specialist or medicine splst for his further treatment?
sud i also go for CPR test alongwith Xray?
pls also suggest if i can go for QuantiFERON®-TB Gold now as i came to know just now that this test is 100% confir test for TB? and if it is negative for TB can i discontinue the TB medicines at this stage?
MEDICAL PROFESSIONAL
Hello!
A weight gain of 8kgs for 2 months is a good sign after taking AKT4. Good that you are hungry and I would suggest you to take good protein diet and milk which is rich in calcium and protein.
Your treatment will continue for atleast 4-6 months.
Discuss with your TB specialist or orthopedician as when to start 2 drug?
Go for a present day X-ray.
You would need isoniazid and rifamipicin for next 4-6 months after taking AKT 4 for 2 months. In some cases AKT 4 is taken for 3 months.
Take care!
A weight gain of 8kgs for 2 months is a good sign after taking AKT4. Good that you are hungry and I would suggest you to take good protein diet and milk which is rich in calcium and protein.
Your treatment will continue for atleast 4-6 months.
Discuss with your TB specialist or orthopedician as when to start 2 drug?
Go for a present day X-ray.
You would need isoniazid and rifamipicin for next 4-6 months after taking AKT 4 for 2 months. In some cases AKT 4 is taken for 3 months.
Take care!
dear indu
it is better sign that u r feeling hunger now it means that u r recovering from TB
wat is ur fever chart?
when u tested ur ESR 1st time and what was the value
it is better sign that u r feeling hunger now it means that u r recovering from TB
wat is ur fever chart?
when u tested ur ESR 1st time and what was the value
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