Tuberculosis of the Spine (TB Spine/Pott’s Disease)

Tuberculosis of the spine, also called TB spine or Pott’s disease, is a form of tuberculosis that has spread to the bones of the back. It often starts after TB in the lungs or another organ and slowly spreads through the bloodstream to the spine. Most people first notice ongoing back pain. Not sharp pain, but a constant ache or stiffness that does not settle with rest. Some feel tired easily. Some lose flexibility. Others realise they cannot bend or turn the way they used to.

It does not always show dramatic symptoms at the beginning, which is why it is sometimes diagnosed later than expected. Early evaluation makes a difference because untreated disease can weaken the bones, change posture, and put pressure on nerves.

TB bacteria can travel from the lungs to the spinal column. They settle in the bone and the disc space between the vertebrae. The lower thoracic and upper lumbar areas are common places, but it can appear anywhere along the spine. Once the infection settles there, the bone becomes inflamed. Over time, stability can be reduced. The disc space may narrow. In advanced cases, the bone may collapse, affecting posture.

This is not sudden; it progresses slowly. That is why regular checkups are essential once TB spine is suspected.

Anyone with tuberculosis can develop spinal involvement. Some are at higher risk:

• People with untreated TB

• Interrupted or incomplete TB medication courses
• Weak immunity or long-term illness

• Delayed diagnosis

But it can also appear in people without obvious risk factors. So, symptoms should be checked even in the absence of a typical TB history.

Symptoms grow gradually. People describe them differently. Examples:

• Back pain that does not improve with rest

• Stiffness after sitting or lying down
• A sense of weakness or heaviness in the back
• Fatigue, low appetite, or gradual weight loss

• Mild fever or night sweats in some cases

When the infection progresses:

• Weakness or tingling in the legs may appear

• Difficulty walking or climbing stairs
• Balance problems or dragging of the foot
• A curve or visible change in posture

• Pain moving from the spine to the legs if nerves are involved

On their own, these symptoms do not prove it is TB. They simply tell the doctor that the spine needs to be investigated to see if the problem is tuberculosis or something else.

Diagnosis is based on symptoms, examination, and investigations. Not one test alone. Usually a combination:

• X-ray to look for changes in the bone

• MRI to understand nerve pressure, abscess, or spinal cord involvement
• CT scan to check the structure more clearly, if needed
• Blood tests for signs of inflammation or infection

• TB tests, such as GeneXpert, culture, or tissue biopsy, are used when confirmation is needed

A biopsy may be advised if clarity is required before starting treatment or if the response to medication is unclear.

The primary treatment for TB of the spine is a full course of anti-tubercular therapy (ATT). Medicines are taken for several months, and the duration of treatment varies from person to person. The doctor determines the duration after reviewing the stage of the disease, the state of the spine on scans, and whether nerves are under pressure. Sticking to the full course of medicines matters. When tablets are missed or stopped early, the infection may persist, and the risk of later problems increases. The doctor reviews progress during follow-up and adjusts treatment only when it is medically appropriate.

Along with ATT, supportive steps are used according to the patient’s condition:

• Early on, some people are asked to limit strain on the spine so the area can settle.

• A brace may be recommended if the bone needs extra support during healing.
• Pain relief is adjusted as needed based on the person's response at that stage.
• Physiotherapy is added later in the treatment, once the spine is ready for movement. It is not started at the beginning, because early strain can interfere with healing.

• When the plan is followed step by step with medication, regular check-ups, and gradual activity, many patients begin to feel improvement. Progress may be slow in the early stages, but each review helps guide the next treatment decision.

Surgery is considered only when there is a medical reason, such as pressure on the nerves or a spine that has become unstable.

Surgery is discussed when there is a medical reason. Situations include:

• Weakness in the legs due to nerve pressure

• Difficulty walking or loss of balance
• Severe spinal instability or collapse
• Large abscess pressing on important structures
• Persistent pain despite medication

• Need for tissue diagnosis when reports are unclear

At Gleneagles Hospitals, surgery is considered only when medically necessary. If required, the procedure is planned to remove infected tissue, create space around the nerves, and stabilise the spine so it can safely carry weight. In some patients, the spine needs extra support because the bone is fragile. The exact method is chosen after reviewing the scans and the patient’s condition, with attention to safety, nerve protection, and long-term movement.

Recovery is different for each patient. Some notice improvement within a few weeks, while others need more time to regain strength. Follow-up visits help the doctor assess healing, review scans as needed, and adjust the plan as needed. Physiotherapy is added slowly, once the spine is ready for movement.

Daily activities return slowly:

• Light routine work first

• Sitting and standing with care
• Lifting restrictions for a while

• Avoiding sudden bending or twisting until advised

Strength returns step by step.

Complications are more likely when the diagnosis is late or the treatment is interrupted:

• Nerve weakness or numbness

• Difficulty walking
• Change in spinal shape due to collapse
• Ongoing back pain or stiffness

• Chronic infection if medication is incomplete

These are not guaranteed outcomes. There are reasons to stay consistent with treatment and follow-up.

At Gleneagles Hospitals, TB spine is managed using a patient-specific plan rather than a single approach for everyone. The focus is to confirm the diagnosis, initiate appropriate treatment, and preserve the spine's strength and stability. Each case is reviewed by doctors who specialise in TB of the spine and nerve-related problems. The treatment plan is built around the patient’s condition, not a single routine for everyone.

What patients can expect at Gleneagles:

• Assessment by clinicians experienced in spinal TB

• Imaging as needed, such as X-ray, MRI, or CT, to understand the extent of involvement
• Medical treatment planned according to current TB protocols
• Surgery is considered only when scans or symptoms show it is necessary

• Follow-up appointments to track recovery and modify care when required

The aim is steady improvement, symptom control, and recovery at a pace that suits the patient’s health and daily needs.

TB of the spine is treatable. The key is recognition, correct diagnosis, and a complete course of treatment. Surgery is reserved for situations in which the spine or nerves require protection. As treatment progresses and follow-up continues, most patients start to recover function and move back toward daily life step by step.