Spine Tuberculosis Diagnosis | Dr. Sudheer Pothu

Patients with relevant symptoms and risk factors should be suspected of having spine tuberculosis. To confirm the diagnosis, the following tests are recommended:

1. X-ray: Shows disc height loss, vertebral collapse, and spinal deformity.

X-ray

2. MRI Scan: Reveals detailed infection information, such as disc and vertebral body involvement, spinal cord compression, and treatment response. Contrast MRI is preferred. However, it cannot confirm tuberculosis alone; a biopsy is needed.

MRI Scan

3. CT Scan: Provides detailed bony anatomy information like end plates status, pedicle & posterior bony elements integrity . It also assesses bone healing status in already under treatment patients.

CT Scan

4. Culture and Sensitivity: Determines the type of tuberculosis and guides medication selection based on bacterial response to different drugs.

5. Other tests:
-HRCT chest and sputum test to rule out lung infection
-Blood tests like CBC, ESR, CRP to assess infection severity and progress.
-Tests to rule out other bacterial infections like Urine culture, blood culture, etc.

6. Biopsy: Essential for confirming the diagnosis and differentiating between infections and tumors. Also used for culture and sensitivity testing to determine effective antibiotics.
- CT Guided Biopsy: Retrieves material using a needle guided by CT imaging.

- Fluoroscopy Guided Biopsy: Collects target material using an intra-operative x-ray machine.

- Surgical Biopsy: Performed when other biopsy methods fail or are impractical.

7.GeneXpert/CBNAAT :
GENEXPERT is a diagnostic technology used for the detection of various infectious diseases, including tuberculosis (TB). It is a nucleic acid amplification test that detects the DNA of the bacteria causing TB, Mycobacterium tuberculosis.
It offers certain advantages in diagnosing TB, including spine tuberculosis:

1. Rapid results: Provides results within a few hours itself.
2. High sensitivity: high sensitivity in detecting M. tuberculosis DNA, even in samples with a low bacterial load.
3. Simplicity: simple to perform and does not require extensive laboratory expertise. It can be used in settings with limited resources and in areas where skilled personnel are scarce.

To perform a GeneXpert test for spine tuberculosis, a Tissue sample is obtained by biopsy from the affected part of the Spine. The collected sample, such as a tissue biopsy or aspirate, is then processed and analyzed using the GeneXpert system.

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