Why did my doctor suggest surgery for spinal TB, despite improvements in symptoms with medication?

Q. Is surgery mandatory in a patient with spinal TB despite normal diagnostic reports and improvements in symptoms?

Answered by
Dr. Palani Kumar Chellamuthu
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Oct 06, 2022

Hi doctor,

I was diagnosed with spinal TB five years ago in the middle of the year. The pain began at the end of the year, and I have been under medication for the past seven months. Initially, my pain was so severe that I could not get out of bed, but my pain is subsiding now. My weight was 53 kgs a few months ago, and now I weigh 59 kgs. I am able to perform all activities, but the doctors say there is no improvement in my condition, and they suggested that I undergo surgery. Please, tell me what to do. I am scared of surgery. And if I am not recovering, why was the pain subsiding? In addition, I underwent a biopsy, blood culture test, and fungal test, and all the reports were normal. Also, I am planning to join my office soon. So, should I undergo surgery or not?

Kindly give me your suggestions.



Welcome to icliniq.com.

I went through your query and understood your concern.

I am glad to know that your condition has improved, and I assume you are still on Anti-TB (tuberculosis) treatment drugs.

1. Your X-rays and scan reports show your TB is healing (attachment removed to protect the patient's identity).

2. Your ESR (erythrocyte sedimentation rate) test is decreased, which denotes healing.

3. Your last MRI (magnetic resonance imaging), which was taken five years ago, shows changes in TB but does not mention anything about the abscess that was reported in the earlier results.

4. Was a biopsy and culture, TB-PCR (tuberculosis polymerase chain reaction) sample taken from the involved area? And is the treatment based on drug sensitivity?

5. If your weight has increased, you need to consult an infectious disease physician regarding the adjustment of the tablets, as the dosage is calculated based on the weight.

6. I suggest you to undergo an anterior-posterior and lateral X-ray view of the lumbar spine.

7. I also suggest you take bed rest, perform ambulation within pain limits, and use lumbar sacral corsets.

8. I would suggest that X-rays and clinical improvement are a better way of following the healing process in cases like TB spine. However, I believe you are progressing and suggest you to continue taking the medications for 15 to 18 months. Also, kindly send me all the X-ray reports.

Kindly consult a specialist, talk with them and take the medications with their consent.

I hope this was helpful.

Take care.

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