How to Diagnose Spinal Tuberculosis

Spinal tuberculosis is an infection of the spine by the Mycobacterium tuberculosis bacterium. It is one of the oldest known diseases and has plagued mankind since Neolithic times. Spinal tuberculosis is still a common disease in developing countries, although it is now rare in the United States. Tuberculosis is contagious and can cause permanent neurological damage and spinal deformities, especially in developing children.

Instructions

Difficulty: Challenging

1. Realize that the average patient will have had symptoms of spinal tuberculosis for 3 to 4 months before seeking medical help. Back pain is usually the earliest symptom and the pain may be radicular or spinal. Fever and weight loss also may be present.
2. Expect spinal tuberculosis to affect the lower thoracic spine (45 percent) and the lumbar spine (40 percent) in most cases. Neurological abnormalities will exist in half of these cases, including cauda equina syndrome, impaired sensation, nerve root pain, paraplegia and paresis.
3. Observe tuberculosis of the cervical spine in 10 percent of the cases. This is potentially more serious because complications are more likely. This form causes pain and stiffness and may be accompanied by difficulty in swallowing or high-pitched respiration.
4. Perform laboratory tests when spinal tuberculosis is suspected. A Tuberculin skin test is positive in about 90 percent of patients who are HIV negative and the Erythrocyte sedimentation rate may be greater than 100 mm/hr.
5. Confirm the diagnosis by culturing Mycobacterium tuberculosis from bone or abscess samples. These findings will be positive in only half of the cases.