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Persistent, long-term back pain is one of the most common signs of spinal tuberculosis, often accompanied by muscle weakness in the arms or legs
Pulmonary TB can often be confirmed through sputum tests, spinal TB usually requires advanced imaging such as MRI or CT scans, and in some cases, tissue sampling. (Image: Canva)
Globally, tuberculosis remains the leading cause of death and according to the World Health Organization, over 10.7 million people fell ill with TB in 2024, with more than 1.25 million deaths recorded globally. Despite decades of medical advances, the disease persists at a scale that is difficult to ignore.
Every year on March 24th, the world observes World Tuberculosis Day, a moment to bring the disease back into public focus and strengthen collective efforts to address it. Tuberculosis, commonly known as TB, is among the oldest known infectious diseases, yet it continues to pose a significant public health challenge, affecting millions each year across geographies and age groups.
Dr. Simon Thomas, Joint Replacements specialist explains that the challenge lies in distinguishing these cases from routine orthopaedic complaints. “Back pain is one of the most common reasons patients visit an orthopaedic clinic, and most cases are mechanical or lifestyle-related. In India, where TB remains a major public health concern, nearly 15–20% of cases are extrapulmonary, affecting areas beyond the lungs, including the musculoskeletal system, where the spine is among the more serious sites of involvement.”
Extrapulmonary is a lesser-known forms of tuberculosis commonly known as Pott’s disease, a condition that often begins with symptoms as common as back pain, making it easy to overlook in its early stages.
What Is Pott’s Disease?
Pott’s disease, or spinal tuberculosis, is a bacterial infection that affects the vertebrae, making it one of the most serious forms of bone-related TB. It falls under extrapulmonary tuberculosis, meaning the infection does not remain confined to the lungs. In most cases, the disease begins in the lungs and gradually spreads to the spine through the bloodstream.
The condition often develops slowly, with symptoms that can be easy to overlook in the early stages. Persistent, long-term back pain is one of the most common signs, sometimes accompanied by muscle weakness in the arms or legs. As the disease progresses, it can lead to structural damage in the spine, including deformities such as a curved spine or weakened vertebrae.
If left untreated, spinal TB can result in severe complications and, in some cases, may be life-threatening. Despite being less commonly discussed, Pott’s disease remains the most frequent form of skeletal tuberculosis.
What Are The Symptoms of Spinal Tuberculosis?
Dr. Simon Thomas is a Senior Director, Robotic Joint Replacements and Orthopaedics at Max Super Speciality Hospital, Shalimar Bagh, adds further, “Spinal tuberculosis, presents much more quietly, with symptoms that closely resemble these common conditions. It is often only when pain persists despite rest or standard treatment, or when it is accompanied by subtle systemic signs such as fatigue or low-grade fever, that the possibility of an underlying infection is considered. By then, in some patients, the disease may have already progressed to a stage where structural damage has begun.”
The challenge with extrapulmonary TB lies in how it presents. Unlike pulmonary TB, which is marked by a persistent cough and respiratory symptoms, TB affecting other parts of the body tends to be quieter, slower, and less specific.
Clinical data suggests that extrapulmonary TB accounts for nearly one-fifth of all TB cases globally, with lymph node involvement being the most common, followed by pleural TB. Bone and joint TB, including spinal TB, represents a smaller proportion but carries serious consequences if undiagnosed. One of the defining features of spinal TB is how easily it blends into everyday health complaints.
Early symptoms often include:
- Back pain lasting more than two to three weeks
- Stiffness or reduced spinal mobility
- Fatigue that persists despite rest
- Low-grade fever
- Gradual, unexplained weight loss
Individually, these symptoms may seem insignificant. Even collectively, they may not immediately point towards an infection. This is why many cases are identified only after the disease has progressed.
In some patients, early symptoms can be mild enough to ignore, creating the impression that the condition is not serious—until it becomes difficult to manage.
How Does Spinal TB Differ from Pulmonary TB?
Spinal tuberculosis behaves very differently from the form most people recognise.
Pulmonary TB typically progresses with visible, often disruptive symptoms—persistent cough, fever, and chest discomfort which prompt early medical evaluation. In contrast, spinal TB develops gradually, often over weeks or months, and remains localised to the vertebrae.
Dr Simon notes, “What makes orthopaedic TB particularly concerning is how subtly it develops, often with symptoms that are easy to overlook in the early stages. Persistent back pain lasting more than two to three weeks, stiffness that does not improve with rest, low-grade fever, especially in the evenings, and unexplained fatigue or weight loss are warning signs that warrant attention.”
“When joints such as the hips or knees are involved, patients may notice swelling, pain while walking, or reduced movement, which can gradually interfere with daily activities.”
There are no respiratory symptoms to trigger suspicion. Instead, patients are more likely to consult orthopaedic specialists for back pain, which can delay the consideration of an infectious cause.
Diagnosis is also more complex. While pulmonary TB can often be confirmed through sputum tests, spinal TB usually requires advanced imaging such as MRI or CT scans, and in some cases, tissue sampling. This added complexity contributes to slower detection.
For most people, tuberculosis is synonymous with coughing. When that symptom is absent, the possibility of TB is rarely considered. Persistent back pain is more commonly linked to:
- Poor posture
- Sedentary lifestyle
- Muscle strain
- Age-related degeneration
This assumption often leads to self-medication or delayed medical consultation. Even within clinical settings, the overlap with routine orthopaedic issues can result in initial misdiagnosis.
Who is More Vulnerable to Spinal TB?
While TB can affect anyone, certain groups are more at risk, particularly for extrapulmonary forms.
These include:
- Individuals with weakened immune systems
- People with chronic conditions such as diabetes
- Those experiencing malnutrition
- Individuals with prolonged exposure to active TB cases
Research also indicates that immune response plays a key role in determining whether TB remains confined to the lungs or spreads to other parts of the body. This makes overall health and living conditions important factors in disease progression.
March 24, 2026, 15:03 IST
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