Operation to produce surgical fusion of the spine is a comparatively safe procedure. It may be performed without danger of aggravating the disease process. It aids in giving stability to the diseased portion of the spine. It does not necessarily prevent extension of the disease, formation of abscess, irritation of the spinal cord, or paraplegia among patients whose resistance is not good. It is best to delay spine fusion for children who are sick; then, when the process becomes quiescent, spine fusion can be employed as an internal splint to aid in ankylosis. The results of spine fusion as a treatment for tuberculosis of the spine are probably better in adults than in children. An operation that produces fusion of the entire region of involvement gives better immobilization and, consequently, better results than does one that effects fusion of a more limited region. It is often impossible, in the early stages of tuberculosis of the spine, to determine the exact extent of the process either by clinical or by roentgenographic examination.
At the end of five years, 396 of our 480 patients had been traced; of these 396 patients, 63.64 per cent. had returned to an occupation, 7.83 per cent. had obtained improvement, 3.79 per cent. had had temporary improvement with relapse later, 6.31 per cent. had had no improvement, and 18.43 per cent. had died.
The best results are obtained when patients are carefully selected for operation, when spine fusion is employed during the period of healing of the disease, and when such treatment is reinforced by conservative treatment for a prolonged period of time.
The paramount requirement for every patient who has tuberculosis of the spine is rest, heliotherapy, and a nutritious diet. No surgical treatment can offset the value of conservative treatment.
ETIOLOGY of Tuberculosis of Spine
• Causative organism: Mycobacterium tuberculosis.
• Spread: Haematogenous. (by blood)
• Commonly associated with: Debilitating diseases, AIDS, Drug addiction, Alcoholism.
Symptoms of Tuberculosis of Spine
The onset is gradual.
• Back pain is localised.
• Restricted spinal movements.
• Night sweats.
• Weight loss.
• There may be kyphosis. (spinal curvature)
• Muscle wasting.
• A paravertebral swelling may be seen.
• They tend to assume a protective upright, stiff position.
• If there is neural involvement there will be neurological signs.
• A psoas abscess (may present as a lump in the groin and resemble a hernia).
• Pyogenic osteitis of the spine.
• Spinal tumours.
INVESTIGATION for Tuberculosis of Spine
• TLC: Leucocytosis.
• ESR: raised during acute stage.
Tuberculin skin test
• Strongly positive.
• Negative test does not exclude diagnosis.
Aspirate from joint space & abscess
• Transparency: turbid.
• Colour: creamy.
• Consistency: cheesy.
• Fibrin clot: large.
• Mucin clot: poor.
• WBC: 25000/cc.mm.
• Shows granulomatous tubercle.
• Narrowed joint space.
• Diffuse vertebral osteoporosis adjacent to joint.
• Erosion of bone.
• Fusiform paraspinal shadow of abscess in soft tissue.
• Destruction of bone.
• Wedge-shaped deformity (collapse of vertebrae anteriorly).
• Bony ankylosis.
• Vertebral collapse resulting in kyphosis.
• Spinal cord compression.
• Sinus formation.
• Paraplegia (so called Pott’s paraplegia).
GENERAL MANAGEMENT for Pott’s Disease
• Bed rest.
• Immobilisation of affected joint by splintage.
• Nutritious, high protein diet.
• Drainage of abscess.
• Surgical decompression.
Homeopathy Treatment & Homeopathic Remedies for Spinal Tuberculosis
Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution etc. A miasmatic tendency (predisposition/susceptibility) is also often taken into account for the treatment of chronic conditions. The medicines given below indicate the therapeutic affinity but this is not a complete and definite guide to the treatment of this condition. The symptoms listed against each medicine may not be directly related to this disease because in homeopathy general symptoms and constitutional indications are also taken into account for selecting a remedy. To study any of the following remedies in more detail, please visit our Materia Medica section. None of these medicines should be taken without professional advice.
Pain as if sprained; can scarcely rise; from overlifting. Pain between shoulder-blades, impeding breathing. Rheumatism in lumbar region; weakness in small of back. Curvature of dorsal vertebrae. Nape of neck stiff and rigid.
Calc carb suits to person with Leucophlegmatic constitution, blond hair, light complexion, blue eyes, fair skin; tendency to obesity in youth. Psoric constitutions; pale, weak, timid, easily tired when walking. Disposed to grow fat, corpulent, unwieldy. Children with red face, flabby muscles, who sweat easily and take cold readily in consequence. Large heads and abdomens; fontanelles and sutures open; bones soft, develop very slowly. Curvature of bones, especially spine and long bones; extremities crooked, deformed; bones irregularly developed. Head sweats profusely while sleeping,
Rheumatic pain and stiffness of neck with dulness of head, from slight drought of air. Cramp-like pain in neck first one side then the other (right to left). Throbbing or jerking pains below scapula. Violent pain in region of back when making the least effort. Backache and uterine pains. Sharp pains in sacrum and coccyx. Soreness as if separate in sacro-illiac synchondrosis. Curvature of the spine to the left, lumbar vertebrae bend to the left, spina bifida. Soreness in sacro-iliac symphysis, as if broken.
Calc phos suits to person with anaemic and dark complexion, dark hair and eyes; thin spare subjects, instead of fat.
Tension and cramp-like drawing in muscles of neck, especially on moving head. Miliaria on neck. Boring pain between scapulae. Spondylitis of cervical vertebrae.
Eruption, painful to touch, on back, shoulder-blades, neck, and chest. Burning pain in a spot above small of back. Itching stitch in coccyx, fine stitches in coccyx and sternum. Crawling (formication) tingling in back and loins.
Phos acid best suited to persons of originally strong constitutions, who have become debilitated by loss of vital fluids.
Rigidity of nape of neck. Pressure on shoulders. Swelling of neck. Engorgement of axillary glands and of those of nape of neck and of neck. Paralysed sensation in upper sacrum and lower lumbar vertebrae. Contusive pain in loins and back (as if back were broken), especially after having been seated a long time, hindering walking, rising up, or making the least movement. Pain in small of the back when rising from a stooping position. Sensitiveness of spinous processes of dorsal vertebrae to pressure. Softening of spine. Heat or burning in back, between scapula. Tearings and stitches in and beneath both scapula. Pain in coccyx impeding easy motion, can find no comfortable position, followed by painful stiffness of nape. Coccyx painful to touch as from an ulcer. Transient pain from coccyx though spine to vertex that drew head back during the stool. Backache and palpitations prevail.
Phos best adapted to tall slender persons of sanguine temperament, fair skin, eyelashes, fine blond, or red hair, quick perceptions, and very sensitive nature. Young people who grow too rapidly are inclined to stoop who are chlorotic or anaemic; old people, with morning diarrhea. Nervous, weak; desires to be magnetized Oversensitiveness of all the senses to external impressions, light, noise, odors, touch. Restless, fidgety; moves continually, cannot sit or stand still a moment Burning: in spots along the spine; between the scapulae; or intense heat running up the back;of palms of hands in chest and lungs; of every
organ or tissue of the body generally in diseases of nervous system. Haemorrhage diathesis; small wounds bleed profusely.
Stiffness of nape, with headache. Swelling of glands of nape, in the neck, and under the axillae (with suppuration), sometimes with induration. Suppuration of axillary glands. Caries of clavicle.Stitches between the hips.Coccyx painful, as after a long carriage ride.- Stinging in os coccyges on rising, painful to pressure. -Scabby elevation on coccyx, above fissure of nates.- Pain in the loins, which prevents rising up, and forces patient to remain lying down.- Inflammatory abscess in lumbar region (on the psoas muscle).- Weakness and paralytic stiffness in back, loins, and nape.- Tearings and shootings in the back.- Shootings in the loins, when seated or lying down.-Burning in back when walking in open air and becoming warm.- Aching, shooting, burning, and throbbing in lumbo-sacral region.- Swelling and distortion of spine (curvature of the vertebrae).-Contusive pain between the shoulder-blades.
Silicea best adapted to the nervous, irritable, sanguine temperament; persons of a psoric diathesis. Persons of light complexion; fine dry skin; pale face; weakly, with lax muscles. Constitutions which suffer from deficient nutrition, not because food is lacking in quality or quantity, but from imperfect assimilation. Oversensitive, physically and mentally. Scrofulous, rachitic children with large heads; open fontanelles and sutures; much sweating about the head.
Stiffness of neck, in nape, with paralytic, sprained pain. Child cannot hold head up neck muscles so weak. Tetters on nape. Swelling and inflammation of glands of nape and of neck.Swelling and suppuration of axillary glands. Cracking in vertebrae of neck, especially on bending backwards. Weakness and wrenching pains, or pain as from a bruise in loins, coccyx, and in back, especially on walking, or rising from a seat. Gnawing pain in small of back. Pain in small of back not permitting one to stand erect. Finds himself at night lying on back. Cannot lie on back on account of rush of blood to head. Pain in back after manual labour. Shootings in loins, back, and shoulder-blades, sometimes with obstructed respiration. Sharp and rheumatic pains, drawing, tension, and stiffness in loins, back,and nape. Pinching and burning sensation between the shoulder-blades. Tension and bruised pain between scapulae and in nape, which on moving head goes to shoulders. Stitches beneath scapulae which take away the breath. Drawing in right scapula, evening on going to sleep. Tearing in left scapula while sitting. Needle-shoots at point of left scapula. Sprained pains in back. During whole day aching in small of back, worse when urinating.Distortion (curvature) of spine. Vertebrae softened. Cracking of vertebrae on bending head backward.
Sulphur Adapted to persons of a scrofulous diathesis, subject to venous congestion; especially of portal system. Persons of nervous temperament, quick motioned, quick tempered, plethoric, skin excessively sensitive to atmospheric changes. For lean, stoop-shouldered persons who walk and sit stooping like old men. Standing is the worst position for sulphur patients; they cannot stand; every standing position is uncomfortable. Dirty, filthy people, prone to skin affections. Aversion to being washed; always <. after a bath.
Pain in back from a fall, from sexual excess. Pott’s disease after injury. Psoas abscess. Much used among herbalists in caries of spinal and other bones.
Symphytum facilitates union of fractured bones; lessens peculiar pricking pain; favors production of callous; when trouble is of nervous origin. Irritability at point of fracture; periosteal pains after wounds have healed.