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Ayurvedic Treatment in Conservative Management of Paraplegia Due To Tuberculosis of Spine - A Case Study
Ayurvedic Treatment in Conservative Management of Paraplegia Due To Tuberculosis of Spine - A Case Study
Ayurvedic Treatment in Conservative Management of Paraplegia Due To Tuberculosis of Spine - A Case Study
his publication
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l tuberculosis is often associated with neurological deficit as severe as quadriplegia or paraplegia. Though surgery along with anti tuberculosis
ment (ATT) has promising outcomes; in patients unfit for surgical management or do not show significant improvement, neurological deficit may
t for long time or may be permanent and badly affects quality of life. This patient (58 years old female) of spinal tuberculosis was diagnosed as a
of Asthimajja Gata Vata from Ayurveda’s point of view. In view of paraplegia (Frankel grade A), neurological improvement with only conservative
ment was matter of concern. Patient received ATT (INH, Refampicin, Pyrizinamide, Pyridoxine and Streptomycin) and Ayurvedic medicines -
ora Guggulu, Samshamani Vati and combination of Swarna Malini Vasanta, Abhrak Bhasma and Chausasti Pippali, along with Abhyanga with
aila and Matra Basti of Guduchi Siddha Yamaka Sneha. This patient showed significant improvement in neurological deficit within two months of
edic treatment. Complete remission was seen in loss of sensation, back pain, loss of appetite. Muscle power showed significant improvement
0 to 4). Marked improvement was seen in Frankel scale from A to D. Patient showed good tolerance for ATT. Ayurvedic treatment can be helpful
uvant treatment with conventional ATT for faster recovery from neurological deficits, improvement in quality of life as well as for good tolerance
T. Key Words : Pott’s spine, Swarna Malini Vasanta, Guduchi, Tinospora cordifolia (Willd), Basti
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eISSN - 2348-0173
Vol-2 / Issue-2 - March-April - 2014
IJAAM
www.ijaam.org
INTERNATIONAL JOURNAL
OF AYURVEDA & ALTERNATIVE MEDICINE
Bi-Monthly Peer Reviewed International Journal
VOL 2 eISSN
INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE
ISSUE 2 (2014) 2348-0173
1. Lecturer, Dept of Kayachilitsa, Sumatibhai Shah Ayurved College, Malwadi, Hadapsar, Pune
Maharashtra. E mail – dr.vaishalid@gmail.com
2. Lecturer, Dept of Kayachikitsa, PDEA’s College of Ayurved and Research Centre, Sector 27,
Akurdi, Pradhikaran, Pune 411044 Maharashtra. E mail – dr.shaileshd@gmail.com
All articles published in IJAAM are peer-reviewed and can be downloaded, printed and
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Deshpande Vaishali et. al. Effect of Adjuvant Ayurvedic Treatment In Conservative Management of Paraplegia Due to Tuberculosis of Spine:
A Case Study- Int. J. Ayu. Alt. Med., 2014; 2(2):45-50
VOL 2 eISSN
INTERNATIONAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICINE
ISSUE 2 (2014) 2348-0173
Asthimajja Gata Vata. Patient received ATT and she was tailor and used to work on manual
Ayurvedic oral treatment, Abhyanga and Matra pedalling sewing machine daily for ten hours since
Page
Basti. As the patient had decided against surgical 15 years. Physical examination showed
treatment, faster neurological recovery was matter tachycardia (pulse 104/ min), muscle power in
of concern. The patient was treated as per both lower extremities was zero while normal in
Ayurvedic principles of treatment of Asthimajja both upper extremities. Straight leg rising test
Gata Vata [4]. Significant improvement was seen in done passively was painful at 45 0. Reflexes in
muscle power, loss of sensation, straight leg rising upper extremities were normal while in both
and patient improved up to stage D of Frankel lower extremities they were sluggish. Haemogram
scale after 55 days of Ayurvedic treatment along showed raised erythrocyte sedimentation rate
with ATT. Though surgery is proved treatment of (ESR 55 after one hour by Wintrob’s method) and
spinal tuberculosis in patients unfit for surgery or while other parameters were within normal limits
do not show improvement, Ayurvedic treatment (haemoglobin – 13.2 gm%, total leucocytes
Deshpande Vaishali et. al. Effect of Adjuvant Ayurvedic Treatment In Conservative Management of Paraplegia Due to Tuberculosis of Spine:
A Case Study- Int. J. Ayu. Alt. Med., 2014; 2(2):45-50
VOL 2 eISSN
INTERNATIONAL
INTERNATIONAL JOURNAL
JOURNAL OF
OF AYURVEDA
AYURVEDA && ALTERNATIVE
ALTERNATIVE MEDICINE
MEDICINE
ISSUE 2 (2014) 2348-0173
5000/mm3, neutrophils 79, lymphocytes 28, disease and shows pain mainly during
eosinophils 2). Urine investigation showed movement.[6] Asthi Majjagata Vata specifically
moderate protein loss and suggested urinary mentions about destruction of joint structure
infection (Pus cells 10 – 15/hpf, epithelial cells 5 – (Bhedo Asthi Parvanam) and power loss (Bala
10/hpf). Other investigations such as liver Kshaya) [7]. Hence considering etiological factors
functions, renal functions, blood sugar and chest and symptoms of patient the patient was
radiograph were within normal limits. Radiograph diagnosed as a case of Asthimajja Gata Vata.
of lumbar spine showed sacralisation of fifth
lumbar vertebra and reduced inter-vertebral space Treatment
at multiple levels in lumbar and dorsal spines. The patient received ATT as advised by spine
Considering the history of recent fall, raised ESR surgeon from KEM Hospital, which included INH
and sudden loss of power in lower extremities 500 mg, Refampicin 450 mg, Pyrizinamide 750 mg
with sluggish reflexes magnetic resonance scan and Pyridoxine 40 mg orally once per day for 18
(MRI) of dorsal and lumbar spine was advised to months. Patient also received intramuscular
patient. MRI showed destruction of adjoining parts injections of Streptomycin 750 mg daily for first 60
of ninth and tenth dorsal spine along with inter- days. Along with ATT patient received Kaishora
vertebral disc suggestive of tuberculosis of spine. Guggulu 500 mg thrice daily after food with warm
Associated epidural, paraspinal soft tissue water, Samshamani Vati 1 gm thrice daily after
represented granulation tissue or abscess and food with warm water. Combination of Swarna
indentation of chord by epidural tissue was also Malini Vasanta 60 mg, Abhrak Bhasma 120 mg and
seen. (Figure 1) Chausasti Pippali 250 mg was given twice daily at
Expert opinion from spine surgeon in KEM empty stomach and at night with honey.
Hospital, Mumbai was taken, who suggested anti Panchakarma treatment included gentle
tuberculosis treatment (ATT) and surgical removal application of Tila Taila on both lower extremities
of abscess and fixation of ninth and tenth dorsal and Matra Basti of Guduchi Siddha Yamaka Sneha.
spines. After discussion with the surgeon about ATT and oral Ayurvedic medicines were started on
cost and risk associated with surgery, patient 27.10.2005, while Abhyanga and Basti were
denied for surgery and agreed to start ATT and started on 18.11.2005.
insisted for Ayurvedic treatment along with ATT.
So the patient continued her admission in hospital TREATMENT OUTCOMES
and received Ayurvedic treatment. After completion of 12 Basti and one month of oral
treatment, loss of power and sensation in both
DIAGNOSIS lower extremities recovered slightly and muscle
In view of MRI, raised ESR and other symptoms it power improved from 0 to 1. But low back pain,
was a case of tuberculosis of spine. Considering the tingling, numbness were same as before.
Frankel classification patient was in Grade A – After completing 25 Basti and 45 days of oral
complete neurological deficit with no sensory or treatment total remission was seen in loss of
motor sparing distal to the spinal lesion. sensation and body ache. Marked improvement
For Ayurvedic diagnosis major etiological factors was seen in muscle power, low back pain, tingling
revealed were excess physical activity involving and numbness. Patient could raise her legs against
both lower extremities for many years as part of gravity up to 10 - 150. Muscle power improved up
tailoring occupation, sitting in improper position to 3.
without any support for back were responsible for After completing 55 Basti and 85 days of oral
strain on Asthi and Majja Dhatu at Kati Pradesh. treatment complete remission was seen in low
47
Due to long working hours and low socio back pain, tingling, numbness, body ache, loss of
economical status the patient could not take meals appetite. Muscle power improved to 4 and patient
Page
at proper timing (Atita Kala Bhojana) and also could raise her right and left leg up to 30 and 450
used to take a lot of stale food (Paryushita Aahara) respectively (Figure 2). Weight increased from 42
and bakery products. These etiological factors to 48 kg. Patient could sit in squatting position and
when present for long time are responsible for could stand using walker for 2 to 3 minutes (Figure
malfunctioning of Agni and collection of Sama 3). So the patient was advised to use tailor’s brace.
Doshas in body. From Ayurveda’s point of view, Patient demanded discharge due to family matters
differential diagnoses considered were Siragata and was discharged on 21.1.2006. At time of
Vata, Sandhigata Vata and Asthimajja Gata Vata. discharge the patient was found to improve from
Symptoms of Siragata Vata have specific mention Frankel’s stage A to stage D – sparing of sensation
of dull pain (Manda Ruja), wasting (Shosha), and useful motor function distal to the spinal
oedema ( Shwayathu) which were absent in this lesion.
patient.[5] Sandhigata Vata is relatively chronic
Deshpande Vaishali et. al. Effect of Adjuvant Ayurvedic Treatment In Conservative Management of Paraplegia Due to Tuberculosis of Spine:
A Case Study- Int. J. Ayu. Alt. Med., 2014; 2(2):45-50
VOL 2 eISSN
INTERNATIONAL
INTERNATIONAL JOURNAL
JOURNAL OF
OF AYURVEDA
AYURVEDA && ALTERNATIVE
ALTERNATIVE MEDICINE
MEDICINE
ISSUE 2 (2014) 2348-0173
She was asked to continue ATT as per schedule issues from patient, related with use of Vasa and
and continue Ayurvedic medicines and Abhyanga. Majja, Yamaka Sneha (sesame oil and ghee) treated
Patient kept regular follow up and continued ATT with Guduchi were used for Basti. Abhyanga with
and Ayurvedic treatment. After completion of ATT, Tila Taila were used as local treatment to avoid
significant improvement was seen. Muscle power wasting due to power loss.
improved to almost normal. Patient could do her Basti is highly recommended in cases of
house hold activities very well and could walk paraplegia, fractures, muscular wasting. [19] It is
using a stick (Figure 4). observed that in this patient though Basti is found
very useful, it needs to be administered for longer
DISCUSSION time. But it should be kept in mind that continuous
Kaishor Guggulu is a classical herbal medicine used use of Sneha Basti can vitiate Doshas and hamper
in gout and arthritis. It reduces oedema function of Agni. [20] Hence status of Agni should be
(Shwayathu) and obstruction (Vibandha) and also accessed daily. As this patient was suffering from
improves appetite.[8] Samshamani Vati is herbal anorexia at time of admission, Basti were started
preparation containing Guduchi (Tinospora three weeks after starting oral medicines, when
cordifolia Willd). Guduchi is drug of choice in such anorexia was considerably reduced.
patients owing to its Tikta, Snigdha, Agnideepana The objective of treatment in this patient was not
and Rasayana properties.[9] Ether extract of stem of to treat tuberculosis of spine, as conventional
Tinospora cordifolia (Willd) has shown inhibitory treatment was available, but to improve quality of
effect on growth of Mycobacterium tuberculosis at life of patient especially when the patient has
in vitro studies.[10,11] Clinical studies have shown denied for surgical management. Surgical
that simultaneous administration of Guduchi along treatment may not be useful in some cases. In a
with ATT provide better physical and study it is found that 8% of patient did not show
psychological well being by potentiating effect of improvement in spite of ATT and surgical
ATT. [12] It is also well known to prevent treatment.[21] Though conservative treatment
hepatotoxicity due to ATT. [13] It has anti alone is also proved effective in spinal tuberculosis
inflammatory and anti oxidant property. Tinospora the rate of recovery in such cases is slower and
cordifolia (Willd) has been reported to stimulate reported as 2 to 6 months.[22] But in this patient it
growth of osteoblasts, increases the differentiation was seen that adjuvant Ayurvedic treatment helped
of cells into osteoblastic lineage and also increases patient in faster recovery in this case. Degree and
the mineralization of bone like matrix making it duration of disability and dependence on others
potent anti osteoporotic medicine.[14] Considering were less. Patients receiving only conservative
these effects in such patient having tuberculosis of management possess a risk of disease reactivation,
spine, Guduchi becomes drug of choice not only severe kyphosis or late instability that can lead to
due to its anti tuberculosis and hepatoprotective paraplegia. [23] As this patient did not show up for
property but also due to its protective and follow up after completing ATT, no comment can
probable restorative effect on spines. Swarna be made on outcomes of Ayurvedic treatment in
Malini Vasant is a herbo mineral combination long run.
containing Suvarna (gold), Mukta (pearls), Hingula Tolerability of ATT was another important
(HgS), Kharpara (Calcium zinc carbonate), Maricha question. Anti tuberculosis medicines are known
(Piper nigrum Linn.) treated with butter and lemon hepatotoxic and produce variety of symptoms such
juice.[15]. It is well known medicine useful in as rash, gastrointestinal intolerance, hepatitis,
improving Dhatwagni. Abhrak (mica) is Snigdha, peripheral neuropathy etc. In such case ATT is
pacifies Vata, Pitta and corrects Kshaya, Deepana stopped till toxic symptoms are resolved. In this
48
and Balya.[16] Pippali (Piper longum Linn.) case due to adjuvant Ayurvedic treatment patient
triturated sixty four times with decoction of Pippali did not show any symptoms of intolerance and
Page
makes it Chausasti Pippali. It is Snigdha, Deepana, could complete ATT in time. As discussed before
pacifies Vata and Kapha and Rasayana. [17] Hence in Ayurvedic medicines are useful as hepatoprotective
this patient combination of Swarna Malini Vasant, with ATT.
Abhraka and Chausasti Pippali will help in relieving Though surgical skills and technology are
Margavarodha of Vata without vitiating Vata . advancing spinal surgeries carry potential risk as
These medicines are known to have positive effect compared to other orthopaedic surgeries. So
in improving Jatharagni as well as Dhatvagni. So it patients in whom, the risk of surgery is higher than
can help in improving digestion as well as the expected outcome, Ayurvedic treatment can be
metabolism, leading to weight gain. Treatment of useful. Also in patients who do not show significant
Asthimajja Gata Vata includes Basti of improvement, alternative treatments, such as this,
Mahasneha[4] and milk or ghee treated with Tikta can be useful.
Dravya.[18] Due to financial constrains and ethical
Deshpande Vaishali et. al. Effect of Adjuvant Ayurvedic Treatment In Conservative Management of Paraplegia Due to Tuberculosis of Spine:
A Case Study- Int. J. Ayu. Alt. Med., 2014; 2(2):45-50
VOL 2 eISSN
INTERNATIONNAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICCINE
ISSUE 2 (2014) 2348-0173
It is an observation in a single case and further 11. Unknown author. The anti--mycobacterial activity of
Tinospora Cordifolia medicinal plant used for the
research in this direction is requuired to establish
treatment of le prosy and Tuberculosis. International
role of Ayurvedic treatment and Panchakarma in Journal of Scientific & Engineering Research 2013; (4):6.
cases of tuberculosis of spine. p. 2953 – 2962.
12. Vyas P, Chandola HM, Ghanc chi F, Ranthem S. Clinical
evaluation of Rasayana compo ound as an adjuvant in the
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Deshpande Vaishali et. al. Effect of Adjuvannt Ayurvedic Treatment In Conservative Management of Paraplegia Due to Tuberculosis of Spine:
A Case Study- Int. J. Ayu. Alt. Med., 2014; 2(2):45-50
VOL 2 eISSN
INTERNATIONNAL JOURNAL OF AYURVEDA & ALTERNATIVE MEDICCINE
ISSUE 2 (2014) 2348-0173
50Page
Deshpande Vaishali et. al. Effect of Adjuvannt Ayurvedic Treatment In Conservative Management of Paraplegia Due to Tuberculosis of Spine:
A Case Study- Int. J. Ayu. Alt. Med., 2014; 2(2):45-50
Show abstract
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evaluation of Rasayana compound as an adjuvant in the management of tuberculosis with anti-Koch's treatment
Full-text available Mar 2012
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uli
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and radiological outcomes after conservative treatment of TB spondylitis: Is the 15 years' follow-up in the MRC study
ough?
May 2012 · Eur Spine J
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, H L, Hancock, D O, Hyslop, G, Melzak, J, Michaelis, L S, Ungar, G H, Vernon, J D S & Walsh, J J. The value of postural
on in the initial management of closed injuries of the spine with paraplegia and tetraplegia, Part 1. Paraplegia, 7, 179
Dec 1969 · Paraplegia
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araplegia
Feb 1996 · CLIN ORTHOP RELAT R
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impeded if she is suffering from painful condition like rheumatoid arthritis (RA) in tuberculosis (AMSST) and to investigate the selection strategy of the optimal
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well. Present case is a patient who developed RA one month after full term Due to the lack of support of the anterior columns of multiple segments, AMSST
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