Treatment would depend on the age of the patient, extent of bony destruction, function of the nerves, response to previous nonoperative treatment and lastly, the subjective severity of your pain. The mainstay of nonoperative treatment is the use of antituberculous medications. Adjuvant means of treatment include bed rest for a short period of time, painkillers, muscle relaxants, activity restrictions, liver tonics, vitamin supplements, etc.
Antituberculous medications would need to be taken regularly for a period of at least 6 months. Though the patient would subjectively feel better within just about 1 month of the treatment, taking the full course of medicines is essential to prevent any kind of recurrence of the disease. A common side effect of these medicines is liver dysfunction. Hence, regular monitoring of liver function would be essential. In addition, regular blood tests would need to be carried out at 3-4 weekly intervals so as to monitor the response to treatment.
How should you sleep? You should sleep on your side, either right or left, whichever is comfortable, with a pillow in between your legs. What kind of bed should you sleep on? A cotton mattress is ideal! No need to sleep on hard beds, nor do you need to fall for any kind of so-called “spine-friendly” expensive mattresses sold out in the market! Bed rest would generally not be recommended for more than 3 weeks. In extreme cases, it may be extended up to 3 months. During this period, you should eat, drink and sleep in the bed. Only sponge bath is allowed. Ideally, you should not get up even to visit the washroom; you should use a bedpan or urine-pot. However, if this is too much of an inconvenience, you may be allowed to get up to use the washroom alone.
Though complete bed rest would be prescribed only for a few days to weeks, you would need to have some activity restrictions for a period of at least 12-18 months!! Activities restricted for most spinal patients would include sitting on the floor, bending forwards, lifting weights, smoking, sitting continuously for more than half an hour, using traditional Indian style of toilet commode, driving in a two-wheeler or auto rickshaw or jeep or in any kind of vehicle on bumpy roads.
3-6 weeks following the start of antituberculous medications, based on the extent of recovery, the patient would be started on spinal extension exercises.
You may be prescribed a brace for about 12-18 months. This brace would generally need to be worn at all times other than while lying down.