Tuberculous spondylitis occurs when a tuberculous infection spreads to the spine. Bacterial damage to the spine can cause severe pain, abnormal back curvature, and paralysis. The condition is serious but treatable.

Tuberculous spondylitis is a rare but serious infection that is fatal without medical treatment.

Treatment first addresses the infection. Additional treatments can include attending to any underlying conditions that could be weakening your immune system, and surgery to correct any damage to the spine and backbone.

This article reviews symptoms, risk factors, diagnosis, treatment, and outlook for people with tuberculous spondylitis.

Tuberculous (TB) spondylitis is also called TB of the spine, spinal TB, and Pott’s disease. The condition is caused by the same bacteria that cause tuberculosis.

It occurs when the bacteria travel to the spine and then invade the backbone. Over time, the disease can cause the bones to collapse, leading to spinal abnormalities and a curve in the back.

At first, tuberculous spondylitis causes the symptoms typically associated with TB, including:

Once the infection progresses to the spine, it can cause many additional symptoms. The full extent of symptoms can depend on how far the bacteria spread and on if the bacteria affect the nerves that run through the spinal cord.

Symptoms can include:

  • severe back pain
  • reduced control over limb movement, especially in the legs
  • limb paralysis
  • abnormal spinal bending
  • sharp back curvature

Tuberculous spondylitis is caused by the same bacteria that cause TB: Mycobacterium tuberculosis. This bacterium is contagious and spreads among people who’ve been exposed.

You’re more likely to experience severe complications of the bacteria, such as tuberculous spondylitis, if your immune system is weakened from any health conditions or medications. People with weakened immune systems are at higher risk in certain locations. This includes:

  • correctional facilities
  • homeless shelters
  • developing countries

Even for people with weakened immune systems, TB is rare in the United States.

The first step to diagnosing tuberculous spondylitis is a medical appointment. During your appointment, you and a doctor will discuss your symptoms and medical history.

They’ll likely ask whether you’ve recently been in a part of the world where TB is more common. If your doctor suspects you have tuberculous spondylitis, they’ll order a TB test. This test looks for infection with the TB bacteria.

There are two versions of the TB diagnostic test:

  • Purified protein derivative (PPD) test: A PPD test is a two-step TB test. You might have had this test in the past as part of a pre-employment physical or as one of the required steps before living in a college dorm. This test is done by injecting a protein under your skin that reacts to the TB bacteria and causes a visible bump at the injection sight if TB is present.
  • Blood testing: Blood tests can look for TB. This test is more expensive to do than a PPD test, but it is more often done for people who are suspected of having active TB infections.

Once TB is confirmed, your doctor will likely do additional testing to look for signs of tuberculous spondylitis. This typically includes imaging tests, such as X-rays and MRI.

These tests are done to look at your spine and check for degeneration or abnormalities. MRIs can also detect collections of bacteria in the spine, called epidural abscesses, that can occur with tuberculous spondylitis.

In some cases, you might also have a biopsy. Your doctor might order a biopsy if there is a mass in your spine that could be caused by tuberculous spondylitis or by another condition, such as spinal cancer.

Imaging can’t always detect the difference, so a biopsy will be used to determine whether there are TB bacteria in your spine. During the biopsy, a small sample of the mass will be removed. It will then be tested in a lab for TB.

A treatment plan for tuberculous spondylitis typically has multiple parts. The first part is always treating the TB infection. For most people, TB is treated with a combination of medications taken over several months. TB medication often includes:

  • Ethambutol
  • Isoniazid
  • Pyrazinamide
  • Rifampin

Additional steps will depend on any co-occurring conditions and the extent of spinal damage. This can include treatment for conditions that might be weakening your immune system, such as HIV. Starting treatment for these conditions can help you reduce the risk of additional severe infections.

Spinal damage might need to be treated with surgery. Surgical options can help correct severe curvature and the decompression of the spinal cord. This can help relieve pressure on the nerves and reduce symptoms such as pain and limb paralysis.

All types of TB can be fatal without treatment. However, when managed with the right combination of medications, tuberculous spondylitis can be cured.

The length of time you will need to take medications will depend on the severity of your infection and how well your body responds.

Surgery can help many people find pain relief and regain the use of their limbs.

Tuberculous spondylitis is a rare condition that occurs when tuberculous bacteria spread to the spine. The bacterial infection damages the spinal cord and the surrounding backbones. This can lead to severe pain, paralysis, weakness, and back curvature.

Tuberculous spondylitis is diagnosed through a standard TB test to identify the bacteria. Further diagnosis is made by imagining tests and biopsies to examine spine damage.

Treatment involves medication to resolve the TB infection, treatment of any underlying conditions, and surgery to correct spinal damage.