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Had L4/L5 disc herniation. MRI showed infection on the disc and nerve. Diagnosed with Pott's disease. Possible to avoid surgery with medicines?

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Spine Surgeon
Practicing since : 2002
Answered : 322 Questions
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Sir,
The Q is below mentioned
I had L4/L5 disc herniation 6 weeks back. Doc gave pain killers and pragabalin. As per MRI the nerve dia was 11mm. After taking rest for a month, I developed slight deficit in my left feet thumb. Doctor asked for a repeat MRI and the centre who was doing MRI said that some infection is detected and go for contrast MRI. The results showed infection on the disc and nerve dia 9 mm. My appetite was rereducing, lost some weight, was getting slight fever in evening and chills in the morning. Doc said it is Pott's disease and started with akt4, ofloxacin and b complex. A week back he added Methylprednisolone. ESR is the same since 2 weeks (65). Is there any other medicine which I can take? Am I diagnosed accurately? Can I avoid surgery by taking further medications?
Would share my mri reports through dropbox.
Regards
Posted Sun, 8 Sep 2013 in Back Pain
 
 
Answered by Dr. Rahul D Chaudhari 37 minutes later
Brief Answer:
Anti-Kochs treatment should resolve the infection

Detailed Answer:
We need to discuss if diagnosis is correct? what about treatment? need surgical intervention?
First of all I always try to confirm the diagnosis with tissue sample. I tend to do percutaneous biopsy to get the tissue sample. Histopath of the the tissue sample confirms the diagnosis.
I looked at the reports.Considering L4-5 TB, your doctor has started correct treatment. Response to treatment may take few weeks. I tend to repeat MRI in 6-8 weeks to see for the change.
need for surgical intervention? This is usually decided by the neurodeficit and nerve pressure on MRI and spinal instability. You have mild deficit with moderate pressure and if there is no instability then you can continue with medicinal treatment and absolute rest. To tell you about instability I need to see the MRI images. Thanks.
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Follow-up: Had L4/L5 disc herniation. MRI showed infection on the disc and nerve. Diagnosed with Pott's disease. Possible to avoid surgery with medicines? 3 hours later
Thanks for your reply doc. please advice further after reviewing the mri. Can accupressure or accupuncture help my case? Do you recommend any other treatment?
 
 
Answered by Dr. Rahul D Chaudhari 1 hour later
Brief Answer:
please upload mri images

Detailed Answer:
need to see mri images.
Above answer was peer-reviewed by
 
Follow-up: Had L4/L5 disc herniation. MRI showed infection on the disc and nerve. Diagnosed with Pott's disease. Possible to avoid surgery with medicines? 22 hours later
Link to to view reports: WWW.WWWW.WW
 
 
Answered by Dr. Rahul D Chaudhari 42 minutes later
Brief Answer:
consider doing ct guided biopsy

Detailed Answer:
I looked at the MRI images. It looks like infection but not sure if it is TB or bacterial? I would suggest to consider doing CT guided biopsy and send it for histopath and TB PCR test. Was there any spine injection taken in the past? Thanks.
Above answer was peer-reviewed by
 
Follow-up: Had L4/L5 disc herniation. MRI showed infection on the disc and nerve. Diagnosed with Pott's disease. Possible to avoid surgery with medicines? 24 minutes later
Hello Doctor. Have not taken any spine injection in the past. Are you suspecting discitis? Can it be brucelar discitis which I read on internet that has same symptoms as Pott's. I do not want to sound oversmart to my doc but he never asked for biopsy He never even asked for tb test on skin where the color changes after 2 days. That's why actually I chose online consultation. You pl advice if any further tests need to be done and I will find out in my city and will get it done. If the treatment is correct, it takes how many days for ESR to reduce? The tab medrol 16 mg I think is a steroidal medicine. That can be continued for how many days? I am also taking ofloxacin 200 told to be taken for 20 days by my doc, 18 days completed. Is this the best antibiotic or you suggest some other which would be suitable for TB and/or any other bacterial infection. Wether TB or any infection, can the abcess be removed the biopsy style?
Regards
 
 
Answered by Dr. Rahul D Chaudhari 15 minutes later
Brief Answer:
Need to establish the diagnosis

Detailed Answer:
There is definitely discitis. More common is bacterial and Tb and other like brucellar or fungal is relatively rare however thats why I suggested the CT guided biopsy. Abscess can not be removed by needle. Steriod is usually tapered over the 3 weeks.
At this stage I would suggest to get biopsy as early as possible. Thanks.
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