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Having Back Pain. X-ray Report Revealed Collapse Of D8 Vertebra Is Noted With Retropulsion. What Does This Suggest? Treatment?
Question: Hello Doctor;
My wife is 27years old. She was having back pain since last one and half year. Initially she took that as a normal back pain. In that period also she had a x-ray and everything was normal. So we did not bother at all. When the back pain got worse we showed an orthopaedic surgeon. He told us to get an xray and in the x-ray report it was XXXXXXX PARTIAL COLLAPSE OF D12 VERTEBRA IS NOTED ,LOSS OF LUMBAR LORDOSIS IS SEEN" .So the consult Surgeon suggested for the "MRI DORSAL SPINE".As per the MRI DORSAL SPINE....
[1]-"FINDINGS ARE SUGGESTIVE OF SPONDYLODISCITIS INVOLVING T8 TO T10 VERTEBRAL BODIES & T9/10 INTERVERTEBRAL DISC.MODERATE DEGREE OF DESTRUCTION & PATHOLOGICAL FRACTURE OF T9 VERTEBRA.
[2]-BILATERAL SMALL PLEURAL EFFUSION PRESENT.
[3]-FEATURES ARE LIKELY TUBERCULOUS (KOCH'S) IN ETIOLOGY.
After seeing the above report doctor started TB treatment with AKT-4. But after taking 15 days of AKT-4 she started severe vomiting and stopped that AKT-4. Again after 5 days of stopping AKT-4 we consulted the doctor HE adviced to take the same AKT-4 again. We restarted the AKT-4 and there is no improvement on this again she started vomiting. And this time doctor changed the TB treatment from AKT-4 to AKT-3 with one month STREPTOMYCIN injection for 30 days. After taking of AKT-3 for 15days DR. advices to get a x-ray on dorsal spine AP/LAT. This time x-ray report is as below:
"COLLAPSE OF D8 VERTEBRA IS NOTED WITH RETROPULSION".
So my worry is that :
[1]-2months earlier x-ray was having collapse in D12 vertebra but after 2 months report shows nothing in D12 only "D8 vertebra is noted with repulsion and rest of things are normal". What exactly this report says and any improvement is there in this treatment?
[2]-Only 6 more injection is left but problem is that she can not walk. She can not get up from the bed ,she gets severe at time of using toilet. She loses her balance. Her left side pain severe. Earlier it was not like that. She could able to walk straight without any help. Now a days she cannot walk with out any help. So is this the side effect of injection or is there something wrong and surgeon has to diagnosis?
Please tell me wheather we are going in right track for this treatment yaa something is wrong. Saddest part is she cannot walk now. She gets unbearable pain when she gets up. please advice.
My wife is 27years old. She was having back pain since last one and half year. Initially she took that as a normal back pain. In that period also she had a x-ray and everything was normal. So we did not bother at all. When the back pain got worse we showed an orthopaedic surgeon. He told us to get an xray and in the x-ray report it was XXXXXXX PARTIAL COLLAPSE OF D12 VERTEBRA IS NOTED ,LOSS OF LUMBAR LORDOSIS IS SEEN" .So the consult Surgeon suggested for the "MRI DORSAL SPINE".As per the MRI DORSAL SPINE....
[1]-"FINDINGS ARE SUGGESTIVE OF SPONDYLODISCITIS INVOLVING T8 TO T10 VERTEBRAL BODIES & T9/10 INTERVERTEBRAL DISC.MODERATE DEGREE OF DESTRUCTION & PATHOLOGICAL FRACTURE OF T9 VERTEBRA.
[2]-BILATERAL SMALL PLEURAL EFFUSION PRESENT.
[3]-FEATURES ARE LIKELY TUBERCULOUS (KOCH'S) IN ETIOLOGY.
After seeing the above report doctor started TB treatment with AKT-4. But after taking 15 days of AKT-4 she started severe vomiting and stopped that AKT-4. Again after 5 days of stopping AKT-4 we consulted the doctor HE adviced to take the same AKT-4 again. We restarted the AKT-4 and there is no improvement on this again she started vomiting. And this time doctor changed the TB treatment from AKT-4 to AKT-3 with one month STREPTOMYCIN injection for 30 days. After taking of AKT-3 for 15days DR. advices to get a x-ray on dorsal spine AP/LAT. This time x-ray report is as below:
"COLLAPSE OF D8 VERTEBRA IS NOTED WITH RETROPULSION".
So my worry is that :
[1]-2months earlier x-ray was having collapse in D12 vertebra but after 2 months report shows nothing in D12 only "D8 vertebra is noted with repulsion and rest of things are normal". What exactly this report says and any improvement is there in this treatment?
[2]-Only 6 more injection is left but problem is that she can not walk. She can not get up from the bed ,she gets severe at time of using toilet. She loses her balance. Her left side pain severe. Earlier it was not like that. She could able to walk straight without any help. Now a days she cannot walk with out any help. So is this the side effect of injection or is there something wrong and surgeon has to diagnosis?
Please tell me wheather we are going in right track for this treatment yaa something is wrong. Saddest part is she cannot walk now. She gets unbearable pain when she gets up. please advice.
Hi and thanks for the query,
I understand it can be very difficult at this point in time, but I believe there is hope.
I must say that even without seeing the results of the X rays , I totally agree that treating her for Spinal Tuberculosis is very logical and medically sound. Its true that she is not bearing the Anti TB treatment, strepto injections are good. Will like to address two concerns first:
1. Effectiveness of treatment or not? : Tb is a chronic conditions and the effectiveness of this treatment is not as spectacular as seen in maybe treating common pneumonia. I think its a bit too early to think that the treatment is not effective.
It s true that the deterioration of her neurological state, with worsening or more difficulties to walk have set in. In my opinion, this should purely be a mechanical problem due to a nerve root compression, I suppose. Knowing also whether she has any problems in controlling her bladder or to stool appropriately could be very important. A proper neurological examination is needed in case again, and your neurosurgeon should be able to make a decision.
Its true that everything is in favor of Spinal Tuberculosis, but we should not lose site to some spinal tumors, which could present in a similar fashion. A spinal MRI again to actually ascertain this possibility should be discarded.
2. I would love to propose that other treatment options be added to her therapy especially Vitamin B complexes, which shall be important in fortifying the neurologic aspect. Mobilize her frequently to prevent bed sores and any possibility of thromboembolic disease due to excessive lying down.
I honestly think the treatment offered her is appropriate. Response is not immediate in this case of spinal TB. However, other etiologies of spinal disease with similar presentations like spinal tumors must be considered. A neurologic examination accompanied by a new MRI to exclude an acute spinal compression should be considered. I suggest you visit your Neurosurgeon for a reevaluation with these few suggestions.
Thanks once again and hope this helps, Best regards.
Bain LE, MD.
I understand it can be very difficult at this point in time, but I believe there is hope.
I must say that even without seeing the results of the X rays , I totally agree that treating her for Spinal Tuberculosis is very logical and medically sound. Its true that she is not bearing the Anti TB treatment, strepto injections are good. Will like to address two concerns first:
1. Effectiveness of treatment or not? : Tb is a chronic conditions and the effectiveness of this treatment is not as spectacular as seen in maybe treating common pneumonia. I think its a bit too early to think that the treatment is not effective.
It s true that the deterioration of her neurological state, with worsening or more difficulties to walk have set in. In my opinion, this should purely be a mechanical problem due to a nerve root compression, I suppose. Knowing also whether she has any problems in controlling her bladder or to stool appropriately could be very important. A proper neurological examination is needed in case again, and your neurosurgeon should be able to make a decision.
Its true that everything is in favor of Spinal Tuberculosis, but we should not lose site to some spinal tumors, which could present in a similar fashion. A spinal MRI again to actually ascertain this possibility should be discarded.
2. I would love to propose that other treatment options be added to her therapy especially Vitamin B complexes, which shall be important in fortifying the neurologic aspect. Mobilize her frequently to prevent bed sores and any possibility of thromboembolic disease due to excessive lying down.
I honestly think the treatment offered her is appropriate. Response is not immediate in this case of spinal TB. However, other etiologies of spinal disease with similar presentations like spinal tumors must be considered. A neurologic examination accompanied by a new MRI to exclude an acute spinal compression should be considered. I suggest you visit your Neurosurgeon for a reevaluation with these few suggestions.
Thanks once again and hope this helps, Best regards.
Bain LE, MD.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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