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Q. Diagnosed as Pott’s spine in the L4-L5 region. Severe pain in back as well in the right leg. What to do next?

Answered by
Dr. Anshul Varshney
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 16, 2017

Hello doctor,

Fourteen months ago, my wife went through a C-section delivering a baby girl. After 15 days of surgery, she started feeling lower backache with very local pain in bending, sneezing and coughing. Initially, we thought it is a post-cesarean effect. As she was breastfeeding the baby, she took homeopathic medicines.

Afterwards, we consulted an orthopedic as there was no relief of pain. Three months later, we consulted Neuromedicine. With certain blood investigations and an MRI report, they diagnosed it as a Pott’s spine in the L4-L5 region.

The MRI report said there was an altered T2WI hyperintense and T1WI hypointense signal intensities noted involving the L4 and L5 vertebral bodies with the paradiscal destruction of the L4 vertebral body. A post-contrast study reveals heterogeneous involvement. An irregular peripheral enhancing T2WI hyperintense and T1WI hypointense collection is noted in intraosseous space, prevertebral and paravertebral space extending behind L4 and L5 vertebral level. Small similar collections were noted in the adjacent psoas muscles. Anterior epidural space collection was noted behind L4-L5 level causing spinal canal stenosis. Rest of the vertebrae were normal.

Of late, she has started feeling severe pain in her back as well in the right leg. Right now she is feeling difficulty in moving and walking.

Can you please prescribe her what to do next? They have started the treatment course and suggested to wear an LS belt. The medications are as follows:

  • R-Cin 500 mg OD,
  • Econex 850/300 OD,
  • Pzide 500 BD,
  • Dolo 650 mg BD,
  • Syrup Dicalciiplex N 1 TS BD.

Dr. Anshul Varshney

Critical Care Physician Diabetology General Medicine Internal Medicine Medical Gastroenterology Nephrology Pulmonology (Asthma Doctors) Rheumatology
#

Hello,

Welcome to icliniq.com.

She has Pott's spine that is tuberculosis of the spine and the treatment duration for this is 18 months.

Now, the symptom you have mentioned suggests that she has got severe compression of the nerves of the back aggravated by a jerk.

In such scenario, she needs to apply Taylor's brace on her back to support her back and she may even need rest for a few weeks.

In such cases, I also prefer to add up a medicine which helps in reducing the disc edema and that is a tablet Disperzyme (Bromelain, Trypsin, Rutoside). Consult your specialist doctor, discuss with him or her and with their consent take the medicines.

Regards.

For more information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist


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Thank you doctor,

How severe is compression of nerves? Does she need to visit the doctor or only bed rest is needed? Please reply keeping in mind that we have to go at least 200 to 350 km to visit the doctor? She is taking Powerflam MR (Diclofenac) BD to reduce pain for the last three to four days. Should this be replaced with tablet Disperzyme?

Dr. Anshul Varshney

Critical Care Physician Diabetology General Medicine Internal Medicine Medical Gastroenterology Nephrology Pulmonology (Asthma Doctors) Rheumatology
#

Hello,

Welcome back to icliniq.com.

Go to a nearby physician and an orthopedic surgeon for help.

You should only travel so much only when they call you for a followup.

For the time being, she can continue with the same painkiller.

Disperzyme (Bromelain, Trypsin, Rutoside) can be added for better results. Consult your specialist doctor, discuss with him or her and with their consent take the above medicines.

Regards.

For more information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist


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