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Tuberculosis (TB) of the spine, also known as tuberculous spondylitis, Pott’s disease, or spinal TB, is a rare disease that occurs when the bacteria that causes tuberculosis spreads to the spine and slowly invades backbones. The disease is named after Percivall Pott, a British orthopedic surgeon who first described spinal TB in 1779.

What Causes Tuberculous Spondylitis?

TB is a pulmonary (lung) infection caused by the bacteria Mycobacterium tuberculosis.

Spinal TB, as the name suggests, happens when a TB infection spreads from the lungs to the spine. This spread usually occurs in the middle of the back (thoracic spine) and the lower back (lumbar spine). It’s much less likely to affect the neck (cervical spine). TB can spread to any part of the body, and when it does, it is more broadly called extrapulmonary TB (extrapulmonary means outside of the lungs).

The bacteria invading the spine cause an immune response, creating clumps called granulomas. These clumps form in both the vertebral body (bones of the spine) and the intervertebral discs — the “cushions” sitting between each vertebra. As they grow larger, the granulomas put pressure on the spinal canal and spinal column, which can lead to mobility and movement issues. The larger lesions are called paraspinal masses or paravertebral abscesses. If the clumps grow big enough, they can cause spinal cord compression, resulting in a person’s inability to move their legs (Pott's paraplegia).

The lesions gradually destroy the backbones, causing the spine to collapse and creating back deformities. People living with tuberculous spondylitis can develop kyphosis or kyphotic deformity that is also described as a hunched back. Very sharp and severe deformities between adjacent vertebrae in the mid- to lower back (thoracolumbar) are called Gibbus deformities.

What Are the Symptoms of Tuberculous Spondylitis?

A TB infection will usually cause constitutional symptoms — fever, chills, night sweats, and weight loss. Because TB starts in the lungs, people may also cough up blood.

People with Pott’s disease will usually experience severe back pain. Because many major nerves exit the spine, spinal TB can cause neurological deficits — the inability to move different parts of the body like the arms or legs.

Who Is at Risk for Contracting Tuberculous Spondylitis?

TB is contagious, so TB infection and complications like spinal TB are much more common in people who are exposed to TB. This includes people who have been in prison, homeless, or are from countries where there is a much higher rate of TB. In general, TB is very rare in developed countries, like the United States and more common in developing countries.

People with weaker immune systems are also more likely to get TB and to have their TB spread to other parts of the body, such as the spine. This includes people with HIV/AIDS or other conditions that weaken the immune system.

How Is Tuberculous Spondylitis Diagnosed?

In order to have Pott’s disease, you must first have TB, so one of the first tests would be testing for TB infection. There is a two-step skin test called the PPD test where a TB-specific protein is injected under a part of your skin to see if a reaction forms. If it does, the test is considered positive and means you might have TB. There is also a more expensive, one-step blood test (Quantiferon) that can be performed to test for TB.

In addition to confirming TB infection, scans will usually be done to look at the spine. These images might include X-rays and magnetic resonance imaging (MRI) scans. X-rays can be used to look at the physical condition of the vertebrae and to look for spinal deformities. MRIs can reveal if there is a mass called an epidural abscess — an area where the bacteria has collected.

If a mass is found but it’s inconclusive that the mass is caused by an infection, a doctor might perform a biopsy. During this procedure, a doctor will remove a tiny sample of the mass to observe it under a microscope for signs of the bacteria that causes TB.

How Is Tuberculous Spondylitis Treated?

In any TB infection, the first step is to treat the infection itself. TB is often managed by a combination of four main drugs — ethambutol, isoniazid, pyrazinamide, and rifampin — taken consistently over several months.

In addition, any issues with the immune system (immunodeficiency) that allowed TB to spread across the body would be addressed. For example, if someone is HIV positive, HIV drugs would be started to prevent severe infections from happening again in the future.

Because spinal TB causes bone deterioration, surgical treatment may be needed to correct spinal deformity and spinal cord decompression. Surgical procedures can relieve the pressure on nerves that is causing pain, weakness, and paralysis.

Talk With Others Who Understand

MySpondylitisTeam is the social network for people with spondylitis and their loved ones. On MySpondylitisTeam, more than 66,000 members come together to ask questions, give advice, and share their stories with others who understand life with spondylitis.

Are you or a loved one living with TB spondylitis? Have you found any information or treatments to be helpful? Share your experience in the comments below, or start a conversation by posting on MySpondylitisTeam.