For spinal TB, should we go for surgery?

Question

Hi doctor,

My 27-year-old brother has been suffering from back pain for the last nine months. Nine months ago, his first MRI (magnetic resonance imaging) showed a slipped disc. We initially managed it with painkillers, but prolonged use caused a stomach ulcer, which has now resolved.

In the last 15 days, his back pain has become severe. After a few physiotherapy sessions, his pain worsened, and the physiotherapist advised a repeat MRI (magnetic resonance imaging). I am attaching the latest MRI report for reference.

An orthopedist reviewed the MRI and diagnosed spinal tuberculosis (TB). He initially suggested surgery, but we requested medical management. He prescribed chemotherapy with medications including Benadon 40 mg (Ranitidine), Pyzina 750 mg (Pyrazinamide), Combutol 800+400 mg (Ethambutol + Isoniazid), Nucoxia (Etoricoxib), R-Cinex 600 mg (Rifampicin + Isoniazid), and Protera D (Vitamin D supplement), along with Streptomycin injections.

We are unsure which type of TB this is: drug-sensitive TB, multidrug-resistant TB (MDR-TB), or extensively drug-resistant TB (XDR-TB). Could you advise:

What type of spinal TB is this?
Is surgery necessary, or can it be managed fully with medication?
Any additional precautions or follow-up we should take?

Kindly assist.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern and the situation clearly. In cases where only the spine is involved, sometimes medications alone can be sufficient while monitoring for improvement. However, in your brother’s case, there is both spinal involvement and an abscess (attachment removed to protect patient identity).

An abscess is a collection of pus, and as a general medical principle, any pus collection needs to be drained to prevent complications. Surgery here would serve two purposes:

Drain the pus from the abscess in the psoas muscle
Relieve pressure from the space above the sac of the spinal cord

Because of these reasons, I believe proceeding with surgery is the safest approach.

As for the type of tuberculosis (TB), whether it is drug-sensitive, multidrug-resistant (MDR), or extensively drug-resistant (XDR), this can only be confirmed through microbiological testing of the pus or abscess wall, which is usually done during surgery.

Your brother can continue the current medications as prescribed, and surgery, along with these medications, gives him the best chance for recovery.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.