Q: My 62 years old father is not able to walk for the past one and a half months because of weakness in his legs. He has also started losing sensation in his legs up to the lower portion of the body. Because of this, he cannot move his legs and sit on his own. The MRI reports TB in D-4 spinal cord and so he is under medication. He takes Akurit (4 mg), Andepin (10 mg), Ewas (5 mg), Alp (0.25 mg), Pary (10 mg), Pantocid (40 mg) and Disprin. Do we need any further test to confirm TB? Is it right to start treatment for TB without further confirmation? How long will this treatment take and what are the chances of recovery? Can my father’s problem be treated with operation and will it be safe?

A:Ideally, microbiology evaluation (AFB smear, culture and/or molecular tests) helps in confirming the diagnosis and can also provide drug susceptibility to guide treatment. On the other hand, this requires CT guided aspiration, which is an invasive procedure and carries some risk depending on the clinical profile. The duration of treatment is for a minimum of 1 year and may extend up to 18 months depending on response and clinical evaluation. The treatment of TB shall only remove the infection. The existing damage to bones and nerves may not be reversible, but recovery depends on the extent of disease. Operative intervention may be necessary to stabilise the spine and can be done after 1-2 months of treatment. Usually, in our country TB is a common cause of such problems. Very rarely this presentation may be mimicked by other conditions.