Spinal Tuberculosis (TB of the Spine)

Spinal TB is an infection of the spine that is common in India, and it can be cured with medicines. Most people never need surgery if it is diagnosed early and the full course of medicines is taken. Surgery helps when the infection has pressed on the nerves or weakened the spine.

Reviewed by Dr. Kshitij Chaudhary, Last reviewed September 2026

What Is Spinal Tuberculosis?

Spinal tuberculosis is an infection of the bones of the spine. It is caused by the same germ that causes lung TB (Mycobacterium tuberculosis). It is also called Pott's spine or Pott's disease.

The germ usually enters the body through the lungs. It then travels through the blood and settles in the spine. It most often starts where the disc meets the bone. From there it can soften the bone and form a collection of pus, called an abscess.

It is the most common bone infection in India.

Is Spinal TB Contagious?

TB in the spine does not spread to other people. TB in the lungs can.

Some people with spinal TB also have TB in their lungs, either active or old. That is why we always do a chest X-ray. If your lungs are clear, your family is not at risk from your spine infection.

Who Gets Spinal TB?

Anyone can get it. It is more likely if you:

• Live with, or have been in close contact with, someone who has TB
• Have had TB before, or stopped TB medicines early
• Have a weak immune system, for example from HIV, diabetes, steroid use or poor nutrition
• Live in a crowded city, where TB spreads more easily

Children can get spinal TB too. They need closer follow-up, because their growing spine can bend over time (see below).

How Serious Is It?

With the right medicines, most people recover fully and return to normal life.

It becomes serious when it is caught late. The infection can then:

• Collapse the front of one or more spinal bones, causing a hump (kyphosis)
• Press on the spinal cord or nerves, causing weakness in the legs or arms

Both can be prevented or treated when the disease is found early.

What Are the Symptoms?

Spinal TB usually starts slowly. Many people have pain for weeks or months before it is diagnosed.

Common symptoms:

• Back or neck pain that does not settle after a month
• Pain at night or when lying down
• Loss of appetite and weight loss
• Low-grade fever, especially in the evening
• Tiredness
• A small bump on the back, where one bone sticks out
• A swelling in the neck, along the ribs or in the groin (an abscess that has tracked away from the spine)

Early X-rays are often normal, so spinal TB is easy to mistake for ordinary back pain.

How Is It Diagnosed?

MRI is the best scan. It shows the infection early, shows any abscess, and shows whether the nerves are being pressed. We scan the whole spine, because TB can affect more than one area.

A biopsy confirms the diagnosis. MRI can suggest TB, but other infections and tumours can look the same. A biopsy is a small sample taken with a needle, usually under CT scan guidance and with local anaesthetic. It lets us:

• Confirm it is TB and not something else
• Test which medicines will work on your germ

This matters in Mumbai, where drug-resistant TB is more common. Treating without a sample risks using medicines that will not work.

Where possible, the biopsy is done before starting medicines, because medicines can make the germ harder to find.

A negative GeneXpert does not rule out TB. The culture result is the most reliable.

You will also have a chest X-ray and routine blood tests. Blood tests for TB (such as Quantiferon) and the Mantoux skin test cannot tell old TB from active TB, so we do not rely on them.

Will It Get Worse?

Not if it is treated early and the medicines are taken properly.

Two things are normal in the first three months, and are not a sign that treatment has failed:

• The X-ray or MRI may look slightly worse before it looks better
• The spine may settle a little as the bone heals

You will not need repeat MRIs routinely. We judge progress by how you feel: less pain, better appetite, weight gain and more activity.

In children, the spine can keep bending as the child grows, even after the infection has healed. This is more likely when more than two bones are affected. We check X-rays for specific warning signs, and some children need early surgery to prevent a severe hump later.

How Is It Treated Without Surgery?

Medicines are the main treatment. Most people are treated with medicines alone.

• The first two months use four medicines: isoniazid, rifampicin, pyrazinamide and ethambutol
• After that, three medicines continue: isoniazid, rifampicin and ethambutol
• The total course is usually 9 to 12 months, sometimes longer
• Doses depend on your weight, so let us know if your weight changes a lot

This is a general plan. A chest physician or infectious disease specialist usually manages your medicines alongside us, and your exact plan may vary depending on their advice.

Take every dose, every day, until your doctor tells you to stop. Stopping early, or taking medicines irregularly, is the main reason TB becomes drug-resistant. Drug-resistant TB needs longer, harder treatment, often for 18 to 20 months.

Common side effects include nausea, liver irritation, tingling in the feet, orange-coloured urine and tears (harmless), joint pain, and changes in vision. Do not stop the medicines on your own. Call your doctor, who may adjust them.

A brace may be advised for comfort while the bone heals.

When Is Surgery Needed?

TB of the spine is a medical disease. Surgery treats its complications.

Surgery is usually advised when:

• There is severe weakness, for example you cannot walk across a room
• Weakness gets worse, or appears for the first time, while on medicines
• Weakness does not improve after about six weeks of medicines
• The nerves are pressed by bone or disc rather than soft pus. This kind of pressure does not melt away with medicines
• Several bones have collapsed, or the spine has become unstable
• The hump is large or increasing
• A child shows warning signs of future deformity on X-ray
• The infection is not responding to medicines, or the diagnosis is uncertain

Most people with mild weakness caused by pus or soft infected tissue improve with medicines alone.

If you have been told you need surgery and are unsure, you can send your MRI for a second opinion before deciding.

What Does Surgery Involve?

The aims are to take pressure off the spinal cord and nerves, and to rebuild a stable, straight spine.

Surgery is planned for each person, based on where the infection is, how many bones are affected and your general health. It usually involves:

• Cleaning out the infection: Removing the pus and damaged bone
• Taking pressure off the spinal cord and nerves
• Rebuilding the front of the spine: Using a bone graft or a cage
• Holding the spine with screws and rods while it fuses

In the mid and lower back, most operations are done from the back. In the neck, surgery is usually done from the front. Some people with extensive damage need both, sometimes in two stages.

Tissue samples are always sent from the operation, to confirm TB and test which medicines work.

Screws and rods are safe to use in TB. The infection is still treated fully with medicines after surgery.

What Is Recovery Like?

• Most people are up and walking within a day or two, if they were not operated for nerve weakness.
• A brace may be advised for a few months
• TB medicines continue for the full course after surgery
• Back pain from the infection usually improves quickly
• Nerve weakness recovers more slowly, over weeks to months. The earlier the pressure is relieved, the better the recovery
• We check X-rays to confirm the spine is fusing

Can Spinal TB Be Prevented?

You cannot fully prevent it, but you can lower the risk and catch it early:

• If someone at home has TB, make sure they finish their treatment, and get yourself checked
• Complete every course of TB treatment you are given
• Keep conditions such as diabetes and HIV well controlled
• Eat well; poor nutrition weakens the body's defences
• See a doctor if back pain lasts more than a month, especially with night pain, weight loss or fever

What Questions Should I Ask My Doctor?

• Has the diagnosis been confirmed with a biopsy?
• Have my samples been tested for drug resistance?
• How long will I take the medicines, and who will monitor them?
• What side effects should I watch for?
• Is anything pressing on my spinal cord or nerves?
• Do I need surgery now, or can I try medicines first?
• Will my spine bend over time? (Especially important for children)

Treatments We Offer for This

• CT-Guided Spine Biopsy
• Debridement and Spinal Fusion (TB Spine Surgery)
• Kyphosis Correction (Hump Correction Surgery)

This page is for general information and does not replace a medical consultation. Please see a doctor for advice about your own symptoms.