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M49.0 – Tuberculosis of the Spine
M49.0 is an ICD-10 diagnosis code for tuberculosis of the spine. It describes a mycobacterial infection that can damage vertebrae and intervertebral discs.
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M49.0 is an ICD-10 diagnosis code for tuberculosis of the spine. It describes a mycobacterial infection that can damage vertebrae and intervertebral discs.
What is M49.0?
The ICD-10 code M49.0 refers to tuberculosis of the spine, also known as spinal tuberculosis, tuberculous spondylitis, or Pott disease. It is a form of extrapulmonary tuberculosis in which Mycobacterium tuberculosis infects the vertebral bodies, intervertebral discs, and surrounding soft tissues. This condition is one of the oldest known infectious diseases of the bone and can lead to serious structural damage to the spine if not treated promptly.
Causes
Spinal tuberculosis is caused by the bacterium Mycobacterium tuberculosis. The bacteria typically reach the spine via the bloodstream (hematogenous spread) from a primary infection site, most commonly the lungs. Spread through the lymphatic system also occurs but is less common. Key risk factors include:
- Close contact with individuals infected with tuberculosis
- A weakened immune system (e.g., due to HIV infection, diabetes mellitus, or immunosuppressive therapy)
- Malnutrition and poverty
- Living in or originating from countries with a high prevalence of tuberculosis
- Advanced age
Symptoms
The symptoms of spinal tuberculosis often develop gradually over months to years. Common signs include:
- Back pain, frequently in the thoracic or lumbar spine, which may worsen at rest
- Fever and night sweats
- Unintentional weight loss and general fatigue
- Stiffness of the spine
- In advanced stages: kyphosis (a hunchback deformity known as the Pott gibbus)
- Neurological deficits such as numbness, weakness in the legs, or in severe cases paraplegia (paralysis of both legs)
- Abscesses (collections of pus) around the spine
Diagnosis
Diagnosing tuberculous spondylitis requires a combination of clinical evaluation, imaging studies, and microbiological testing:
- Imaging: MRI (magnetic resonance imaging) is the gold standard for assessing vertebral bodies, discs, and soft tissues. X-rays and CT scans are also used.
- Laboratory tests: Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and full blood count may indicate inflammation.
- Tuberculin skin test (Mantoux test) and Interferon-Gamma Release Assay (IGRA) to detect tuberculosis infection.
- Biopsy: Tissue sampling from the affected vertebra for microbiological and histological analysis is often essential to confirm the diagnosis.
Treatment
Medical Therapy
The standard treatment for spinal tuberculosis is a combination antibiotic regimen, also called anti-tuberculosis therapy (ATT). The typical regimen consists of:
- Intensive phase (2 months): Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol
- Continuation phase (4–10 months): Isoniazid and Rifampicin
The total duration of therapy is generally at least 6 to 12 months, and may be extended in cases with neurological complications.
Surgical Treatment
Surgical intervention may be necessary in the following situations:
- Neurological deficits or impending paralysis
- Spinal instability
- Large abscesses that cannot be managed medically
- Failure of conservative treatment
Supportive Measures
Additional supportive measures such as immobilization (e.g., with a brace), physiotherapy, and nutritional support can promote the recovery process.
Prognosis
With early diagnosis and consistent treatment, the prognosis for spinal tuberculosis is generally favorable. However, long-term complications such as permanent vertebral deformities or neurological damage may occur if the condition is diagnosed late or inadequately treated.
References
- World Health Organization (WHO): Global Tuberculosis Report 2023. Geneva: WHO; 2023. Available at: https://www.who.int/teams/global-tuberculosis-programme/tb-reports
- Rajasekaran S, Soundararajan DCR, Shetty AP, Kanna RM. Spinal Tuberculosis: Current Concepts. Global Spine Journal. 2018;8(4 Suppl):96S–108S.
- Garg RK, Somvanshi DS. Spinal tuberculosis: a review. Journal of Spinal Cord Medicine. 2011;34(5):440–454.
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