I appreciate the way you have explained your symptoms in detail, it is very helpful for a physician.
The regimen for TB of the bone (which comes under extrapulmonary TB) is 2 months of Isonizid, Rifampicin
. This is called the Intensive phase. This is later followed by the maintainence phase of 4 months of Isonizid and Rifampicin only. Total duration of therapy is 6 months. This is the regimen recommended by WHO in DOTS and is also followed in India where TB is very prevalent. We have observed very good results with this regimen in patients with bone TB.
Though Ethambutol has side effects affecting the vision, we donot generally stop it only after 2 weeks. Even though it does not kill the TB bacteria but only stops it from multiplying, it is considered an important drug. Since it was stopped for you, I presume that it was according to the guidelines which are followed in your country. Generally, it would not be significant, but in the light of reappearance of your symptoms, I would consider it significant.Abscess
which is formed due to TB bacteria is called a cold abscess as it does not have any active inflammation. It will gradually disappear with the same treatment. Surgical intervention like drainage
is associated with other effects like formation of a sinus at the drainage site and non healing ulcer. Hence, it is not generally attempted if the abscess is small and is not causing any pressure symptoms. If your abscess is quite big in size it might be another reason for the pain as it might be pinching on the nerve fibres as they come out of the spinal canal
. In this case it might need surgical drainage.
TB also erodes the bone and causes it to collapse upon itself - which may also cause the trapping of the nerves. Surgery becomes the only definitive treatment in this case. Since the new MRI and CT did not show any nerve trapping and bone collapse, we can rule this out.
Apart from this at present I would advice continuation of the TB therapy and an additional one month of intensive phase of the 4 drugs. Since the organism is susceptible, it may prove to be very helpful. You may again have to continue the short course of steroids
for a period of atleast 2 weeks for control of inflammation till then. Please consult your physician for the same.
Hope this helps.