WHY IS A BIOPSY NEEDED IN TB SPINE

Recently a patient asked this question, ‘Doctor. The MRI report is clear that I have TB in the spine. And you have so kindly pointed out that I have TB. So why do you want me to undergo a biopsy?’

After listening to him I realized that this question needed a clear answer as to the need for a biopsy when the diagnosis is TB. I hope that I can clarify.

TB is a great mimic and can fool even the most experienced clinician. The best way to confirm the diagnosis is a biopsy, in which a sample can be procured and forwarded to the laboratory

Here it is processed and subjected to many tests.

1. The diagnosis is confidently confirmed A tissue sample after proper preparation isexamined under the microscope and excludes many sinister conditions like cancer, other infections due to various kinds of disease-causing bacteria or fungi.

2. Polymerase chain reaction or PCR testing of the bacteria in the sample provides evidence of TB.

3. Drug sensitivity testing is always done for front-line drugs like Rifampicin and Isoniazid. This is important as doctors are concerned about the presence of MDR-TB or multi-drug resistant TB.

4. A biopsy is of value in decision-making - for example the need for surgery.

5. In case the response to treatment is not along the expected lines, a biopsy is needed to understand the reasons.

It is understood that Indian patients approach spine surgery with a great deal of skepticism All doctors would like their patients to get well, and in TB spine surgery has specific, inviolate indications.

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