Tuberculosis of the Spine

At Complete Orthopedics, our surgeons specialize in diagnosing and treating spinal infections, including tuberculosis of the spine, also known as Pott’s disease. We take a comprehensive approach that combines modern imaging, medical therapy, and, when needed, advanced surgical techniques to restore stability and protect the spinal cord.

Our offices throughout New York City and Long Island are connected with six leading hospitals that provide the latest diagnostic and surgical technologies. Scheduling an appointment with one of our spine specialists is simple—online or by phone.

How Common It Is and Who Gets It? (Epidemiology)

Tuberculosis remains one of the world’s most common infectious diseases. While it primarily affects the lungs, it can also spread to other parts of the body. Spinal tuberculosis accounts for up to half of all bone and joint tuberculosis cases. It is most common in developing countries and among individuals with weakened immune systems, such as those with HIV, diabetes, or poor nutrition.

Why It Happens – Causes (Etiology and Pathophysiology)

Spinal tuberculosis is caused by the spread of Mycobacterium tuberculosis bacteria from the lungs or another infected site to the bones of the spine. The bacteria travel through the bloodstream or lymphatic system, where they infect the vertebrae and surrounding tissues.

Over time, this infection destroys bone and disc tissue, leading to collapse of the spine, deformity, and pressure on the spinal cord or nerves. The most commonly affected areas are the lower thoracic and upper lumbar regions.

How the Body Part Normally Works? (Relevant Anatomy)

The spine is made of vertebrae separated by discs that cushion and support movement. Behind the vertebrae runs the spinal cord, which carries nerve signals to the body. When tuberculosis infects the spine, it damages the front portion of the vertebrae and discs. As bone weakens, the spine may collapse forward, forming a sharp bend called a kyphotic deformity. If the infection spreads into the spinal canal, it can compress the spinal cord, causing weakness or paralysis.

What You Might Feel – Symptoms (Clinical Presentation)

Symptoms usually develop slowly and may not be obvious at first. Common signs include:

• Persistent back or neck pain

• Stiffness and limited spinal movement

• Fatigue, fever, or night sweats

• Unexplained weight loss

• Swelling or tenderness over the spine

• Weakness, tingling, or numbness in the arms or legs

• Difficulty walking or maintaining balance

• In advanced cases, loss of bladder or bowel control

Without treatment, spinal tuberculosis can cause severe deformity and permanent neurological damage.

How Doctors Find the Problem? (Diagnosis and Imaging)

Diagnosis begins with a detailed medical history, physical examination, and review of symptoms. Doctors look for signs such as spinal tenderness, stiffness, and nerve changes.

Imaging tests are key:

• X-rays show bone destruction or deformity.

• MRI reveals infection in soft tissues, abscesses, and spinal cord compression.

• CT scans provide detailed bone images and help detect early disease.

• Laboratory tests such as blood work, TB skin test, or interferon-gamma release assays help confirm infection.

• Biopsy may be performed to collect tissue for culture and confirm the presence of Mycobacterium tuberculosis.

Classification

Spinal tuberculosis is often classified by location and severity:

• Location: Cervical (neck), thoracic (upper back), lumbar (lower back), or sacral (pelvic) spine.

• Stage: Early (no neurological symptoms) or advanced (neurological impairment or deformity).

• Extent: Single vertebral body, multiple segments, or abscess formation.

Other Problems That Can Feel Similar (Differential Diagnosis)

Several other conditions can mimic spinal tuberculosis, including:

• Pyogenic (bacterial) spinal infections

• Metastatic cancer

• Osteomyelitis from other causes

• Brucellosis

• Degenerative spinal disease

MRI and tissue biopsy help distinguish tuberculosis from these conditions.

Treatment Options

Non-Surgical Care

The cornerstone of treatment is antituberculosis medication, taken for 9–12 months or longer. This regimen typically includes multiple antibiotics to eliminate the bacteria.

Non-surgical treatment also includes:

• Bracing: To support the spine during healing.

• Rest and nutrition: To strengthen immunity and aid recovery.

• Physical therapy: Once pain subsides, gentle exercises help maintain mobility.

Patients showing improvement on medical therapy are closely monitored with periodic imaging.

Surgical Care

Surgery is recommended for patients with neurological symptoms, spinal instability, severe deformity, or when medical therapy fails.

Common surgical goals include:

• Decompression: Removing infected or damaged bone and tissue pressing on the spinal cord.

• Stabilization: Using rods, screws, or bone grafts to restore spinal alignment and prevent collapse.

• Correction of deformity: Straightening severe kyphosis to improve posture and breathing.

Approaches include anterior (front), posterior (back), or combined surgeries, depending on the extent and location of infection.

Recovery and What to Expect After Treatment

Recovery depends on how advanced the disease was before treatment. Patients often stay in the hospital for several days to a week after surgery. Rehabilitation begins early with light movement, followed by gradual strengthening.

Full recovery can take several months. Patients must continue antituberculosis medication for the prescribed duration to prevent recurrence. Regular follow-up imaging ensures proper healing.

Possible Risks or Side Effects (Complications)

Potential complications of spinal tuberculosis or its treatment include:

• Recurrence of infection if medications are not completed

• Residual kyphosis or spinal deformity

• Persistent weakness or numbness

• Infection at the surgical site

• Hardware failure or need for revision surgery

Proper medication adherence and follow-up care greatly reduce these risks.

Long-Term Outlook (Prognosis)

With timely diagnosis and full medical treatment, most patients recover well. Neurological improvement is possible, even in advanced cases, though some may have lasting weakness or mild deformity. Surgical stabilization provides long-term pain relief and mobility.

Patients who delay treatment or have widespread disease may face a higher risk of paralysis or severe curvature. Early intervention leads to the best outcomes.

Out-of-Pocket Costs

Medicare

CPT Code 63085 – Vertebrectomy, thoracic (for decompression of abscess or TB lesion): $472.59
CPT Code 22610 – Posterior spinal fusion, thoracic: $316.71
CPT Code 22842 – Posterior instrumentation, 3–6 segments: $185.26
CPT Code 22015 – Debridement or drainage of paraspinal abscess: $230.99

Under Medicare, patients are responsible for 20% of the approved amount after meeting their annual deductible. Supplemental insurance plans such as Medigap, AARP, or Blue Cross Blue Shield generally cover this 20% coinsurance, leaving patients with no additional costs for Medicare-approved procedures. These supplemental plans are designed to work alongside Medicare, ensuring that patients undergoing complex spine surgeries like those for spinal tuberculosis have minimal or no financial burden.

Secondary insurance—such as Employer-Based Plans, TRICARE, or Veterans Health Administration (VHA)—acts as a secondary payer after Medicare processes the claim. Once the deductible is met, the secondary plan may pay the remaining balance, including co-insurance or non-covered items. Deductibles for secondary plans typically range between $100 and $300, depending on the specific policy and whether the procedure is performed in-network.

Workers’ Compensation
If your spinal tuberculosis developed due to occupational exposure or workplace conditions, Workers’ Compensation will cover the entire cost of surgical and medical treatment, including decompression, fusion, instrumentation, and abscess drainage. You will have no out-of-pocket expenses when your claim is accepted.

No-Fault Insurance
If your spinal tuberculosis treatment is required following a motor vehicle accident that worsened or revealed an existing infection, No-Fault Insurance will pay all costs for evaluation, hospitalization, and surgical care. The only potential patient cost may be a small deductible depending on your insurance policy.

Example
Anita, a 54-year-old patient, required thoracic vertebrectomy (CPT 63085) and posterior fusion (CPT 22610) to stabilize her spine and drain a paraspinal abscess (CPT 22015) caused by spinal tuberculosis. Her total Medicare out-of-pocket costs would have been $472.59, $316.71, and $230.99. Because Anita had supplemental coverage through AARP Medigap, the 20% that Medicare did not pay was fully covered, leaving her with no out-of-pocket expense for her treatment.

Frequently Asked Questions (FAQ)

Q. Is spinal tuberculosis contagious?
A. No. While pulmonary TB is contagious, spinal TB is not spread from person to person.

Q. Can spinal TB be cured?
A. Yes. With full antibiotic therapy and proper follow-up, most patients are cured and regain function.

Q. How long does treatment last?
A. Antibiotic therapy usually lasts 9–12 months. Surgery, if needed, shortens recovery time but does not replace medical treatment.

Q. Will I need surgery?
A. Surgery is recommended if there is nerve compression, deformity, or failure to respond to medications.

Summary and Takeaway

Tuberculosis of the spine, or Pott’s disease, is a serious but treatable infection that can damage the vertebrae and spinal cord. Early detection, long-term antibiotic therapy, and, when needed, surgery can eliminate infection, relieve pain, and restore stability. With appropriate care, most patients recover fully and regain their quality of life.

Clinical Insight & Recent Findings

A recent study from the Spinal TB X Cohort described a case of multi-level spinal tuberculosis (Pott’s disease) confirmed by PET/CT imaging, providing new insight into how advanced imaging can improve diagnosis and follow-up of spinal TB. The case involved a 27-year-old patient with thoracolumbar infection showing multiple active vertebral lesions (T4–7, T11/12, L3/4) detected by PET/CT, which were not fully visualized by MRI.

Over 12 months of anti-tuberculosis therapy, PET/CT scans revealed evolving inflammatory activity — with new lesions at 6 months but significant reduction by treatment completion. These findings highlight the sensitivity of PET/CT for detecting both disease spread and treatment response, surpassing MRI in assessing metabolic activity and residual inflammation.

Persistent uptake at the end of therapy suggests ongoing bone remodeling or subclinical inflammation, underlining the importance of extended monitoring even after clinical recovery. (Study of multi-level spinal tuberculosis and PET/CT imaging – See PubMed.)

Who Performs This Treatment? (Specialists and Team Involved)

Treatment is led by orthopedic spine surgeons and infectious-disease specialists, working closely with radiologists, anesthesiologists, and rehabilitation therapists. This multidisciplinary team ensures complete care—from diagnosis to recovery.

When to See a Specialist?

You should see a spine specialist if you experience:

• Chronic back pain unrelieved by rest or medication

• Weakness or tingling in the arms or legs

• Unexplained fever, weight loss, or night sweats

• Difficulty walking or maintaining posture

When to Go to the Emergency Room?

Seek emergency care if you develop:

• Sudden paralysis or loss of leg movement

• Loss of bladder or bowel control

• Severe back pain with fever or swelling

These may indicate spinal cord compression or abscess formation requiring immediate surgery.

What Recovery Really Looks Like?

Most patients improve steadily once therapy begins. Pain decreases within weeks, and strength returns over several months. Consistent medication use and physical therapy are key to full recovery. Some mild stiffness or residual deformity may remain but rarely affects daily life.

What Happens If You Ignore It?

Untreated spinal tuberculosis can cause collapse of the vertebrae, spinal deformity, paralysis, and permanent nerve injury. The infection can also spread to other organs. Early treatment prevents these serious complications.

How to Prevent It?

Preventing spinal TB involves controlling and detecting TB early:

• Complete treatment for any pulmonary TB infection

• Maintain good nutrition and general health

• Avoid close contact with individuals who have untreated TB

• Strengthen immunity through regular exercise and medical care

Nutrition and Bone or Joint Health

A diet rich in protein, vitamin D, and calcium supports recovery and bone healing. Proper hydration and avoidance of smoking and alcohol promote better immune function and surgical outcomes.

Activity and Lifestyle Modifications

After recovery, maintain gentle exercise such as walking or swimming. Avoid heavy lifting or activities that strain the back. Regular follow-up appointments and imaging help ensure lasting spinal stability and prevent recurrence.

Do you have more questions?