Tuberculosis of the spine

Table 1 Classification of paraplegia in tuberculosis of the spine[24]

Stage	Complaints	Motor	Sensory	Autonomic
I	Nil	Plantar extensor/ankle clonus; ASIA motor score−100	Nil	Nil
II	Able to walk with support	ASIA motor score; Tetra paresis (60–100); Paraparesis (80–100)	Lateral column; Involvement	Nil
III	Confined to bed; Can move limbs	ASIA motor score; Tetra paresis (0–30); Paraparesis (50–80)	Lateral column; Involvement	May be present
IV	No limb movement	ASIA motor score; Tetra paresis (0); Paraparesis (50)	Both lateral and posterior column involvement	May be present
V	Flexor spasms	Flaccid paralysis	Complete loss	Complete loss of bladder and bowel control

Table 2 The first-line anti-tubercular medications' dose, pharmacological activities, and side effects[85]

Anti-tuberculosis drugs	Dose (mg/kg)	Pharmacological activities	Side effects
Isoniazid	5	-Inhibits the enoyl-ACP reductase InhA of the fatty acid synthase type II (FASII) pathway	-Peripheral neuropathy, lethargy, hepatitis, insanity, convulsions, and a lupus-like condition
Rifampicin	10	-Inhibits messenger RNA elongation by binding to the β-subunit of the RNA polymerase	-Hemolytic anemia, gastrointestinal distress, purpura, and orange-red urine stains
Ethambutol	15	-Inhibits enzyme arabinosyltransferases, glycerol metabolism, and RNA synthesis	-Abdominal discomfort, eosinophilia, peripheral neuritis, myocarditis, and hypersensitivity
Pyrazinamide	25	-Disrupts membrane energetics and inhibits membrane transport function	-Hepatotoxicity, pruritis, hyperuricemic arthralgia, and exanthema
Streptomycin	15	-Binds to the small 16S rRNA of the 30S ribosomal subunit irreversibly, interfering with the binding of formyl-methionyl-tRNA to the 30S subunit	-Ototoxicity, rashes, fever, nephrotoxicity, eosinophilia, and vestibulotoxicity