Potts Disease / Spinal Tuberculosis Overview
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Potts Disease / Spinal Tuberculosis Overview

Pott's disease is a tuberculosis that affect the spine. It is an extrapulmonary tuberculosis that originates from the lung and eventually spread to other parts of the body. Delay in diagnosis and treatment of this disease can lead to serious complications that include; spinal cord compression and paralysis also known as Pott's paraplegia.

Pott’s disease also known as tuberculous spondylitis is a form of tuberculosis that affects the spine. It more common in developing countries rather than developed countries and even though, there have been some improvement in health care systems and availability of antituberculous drugs, Pott's disease still remains a major challenge today.  

Pott’s disease usually originates from the infection of lung and gradually spread to other parts of the body through the blood. In most cases, the affected parts are the lower thoracic and the upper lumbar though, sometimes it may also affects the hips and knees. The infection slowly spread from the adjacent vertebrae and later on to the intervertebral disc space.  The  infected intervertebral disc space cannot receive the required nutrients causing it's caseation.  If this happens, the affected disc cannot  hold the two vertebrae in place leading to collapsing of the vertebras and eventually to spinal damage. The patients present with an abnormal curvature of the spine which is known as kyphosis.

Clinical Manifestation

The onset of the signs and symptoms of Pott’s diseases is gradual and at early stages, it may manifest itself with the common signs and symptoms such; malaise, night sweats, headache, fever and weight loss. The patients also experiences localized type of back pain, spinal mass and assumes a protective, restrictive upright position. Prompt management and treatment of these signs and symptoms is crucial since delay in diagnosis and proper interventions can leads to serious complications. As the infection progresses, there would be neural involvement and the patient may start showing signs and symptoms associated with neurological deficit. Further progression of the disease leads to spinal cord compression and Pott’s paraplegia which is basically the paralysis of lower extremities.

Diagnosis

Pott’s disease may be diagnosed by use of various methods;

  • Erythrocytes sedimentation rate (ESR; used to show the level of  inflammation process (increased in acute stage)
  • Test for active tuberculosis (tuberculin text)
  • Biopsy of the spine
  • Spinal X-ray
  • Spinal CT scan

Management

The management of the Pott’s disease depends on various factors such as; the stage of infection and how well the patient is responding to a certain regime. In most cases, the management involves;  

  • Analgesic and antituberculous drugs to control the infection and pain.
  • If neccessary, Immobilization of the affected spine is done
  • Surgery may be preferred for patients that require drainage of abscesses or for patients that needs decompressing the spinal cord.

Prognosis

Prognosis depends on early diagnosis and treatment. If the disease is diagnosed early and treatment started before neurological involvement, then the prognosis is good. If there is delayment in initiation of the management/treatment, this can lead to serious neurological damage .

Prevention

BCG vaccination plays a significant role in preventing tuberculosis and for those patients who are already diagnosed with Tuberculosis or have a positive PPD test, taking all medications as prescribed is very important and reduces the risk of spreading/acquiring the diseases later on.  

Pott’s disease occurs as a result of bacterial infection (mycobacterium) and the best way to prevent this kind of disease is by eliminating or treating it before it spreads to other parts of the body.  There are various tests that can help to rule out this kind of infection such as Purified Protein Derivatives (PPD) and tuberculin test. This tests help in early diagnosis and management of the tuberculosis and is a crucial part in preventing the spread of tuberculosis.

References

http://www.nejm.org/ (New England Journal of Medicine)

http://www.britannica.com/EBchecked/topic/472936/Pott-disease

http://www.ncbi.nlm.nih.gov/pubmed/11339471

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