Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic, progressive back pain, localized spinal tenderness, and constitutional symptoms including night sweats, weight loss, and low-grade fever. History of spinal stiffness, radicular pain, or progressive deformity (gibbus). Neurological review for motor weakness, sensory deficits, or bowel/bladder dysfunction.
Clinical Examination Findings
Physical exam reveals localized spinal tenderness (percussion/palpation) at the affected level. Presence of gibbus deformity or paraspinal muscle spasm. Neurological assessment: motor strength (MRC scale), sensory dermatomal mapping, and deep tendon reflexes. Evaluation for psoas abscess (palpable mass or hip flexion contracture).
Treatment Protocol
Initiation of multi-drug antitubercular chemotherapy (RIPE regimen: Rifampin, Isoniazid, Pyrazinamide, Ethambutol). Spinal stabilization via orthosis (bracing) for mechanical support. Surgical intervention (debridement, decompression, and instrumented fusion) indicated for progressive neurological deficit, spinal instability, or failure of medical therapy.