Pott disease or Pott's disease is a presentation of extrapulmonary tuberculosis whereby disease
is seen in the spinal vertebrae.
Extrapulmonary tuberculosis can affect the spine, a kind of tuberculous arthritis of
the intervertebral joints.
It is named after Percivall Pott, a British surgeon.
The lower thoracic and upper lumbar vertebrae are the areas of the spine most often affected.
Scientifically, it is called tuberculous spondylitis and it is most commonly localized in the thoracic
portion of the spine.
Pott’s disease results from haematogenous spread of tuberculosis from other sites, often
pulmonary.
The infection then spreads from two adjacent vertebrae into the adjoining intervertebral
disc space.
If only one vertebra is affected, the disc is normal, but if two are involved, the disc,
which is avascular, cannot receive nutrients and collapses.
The disc tissue dies and is broken down by caseation, leading to vertebral narrowing
and eventually to vertebral collapse and spinal damage.
A dry soft tissue mass often forms and superinfection is rare.
Signs and symptoms Back pain
Fever Night sweating
Anorexia Spinal mass, sometimes associated with numbness,
paraesthesia, or muscle weakness of the legs Difficulty standing
Diagnosis Blood tests
– CBC: leukocytosis – Elevated erythrocyte sedimentation rate:
>100 mm/h Tuberculin skin test
– Tuberculin skin test results are positive in 84–95% of patients with Pott disease
who are not infected with HIV.
Radiographs of the spine – Radiographic changes associated with Pott
disease present relatively late.
The following are radiographic changes characteristic of spinal tuberculosis on plain radiography:
Lytic destruction of anterior portion of vertebral body
Increased anterior wedging Collapse of vertebral body
Reactive sclerosis on a progressive lytic process
Enlarged psoas shadow with or without calcification
– Additional radiographic findings may include the following:
Vertebral end plates are osteoporotic.
Intervertebral disks may be shrunk or destroyed.
Vertebral bodies show variable degrees of destruction.
Fusiform paravertebral shadows suggest abscess formation.
Bone lesions may occur at more than one level.
Bone scan CT of the spine
Bone biopsy MRI
Late complications Vertebral collapse resulting in kyphosis
Spinal cord compression Sinus formation
Paraplegia Prevention
Controlling the spread of tuberculosis infection can prevent tuberculous spondylitis and arthritis.
Patients who have a positive PPD test may decrease their risk by properly taking medicines
to prevent tuberculosis.
To effectively treat tuberculosis, it is crucial that patients take their medications exactly
as prescribed.
Therapy Non-operative – antituberculous drugs
Analgesics Immobilization of the spine region different
types of braces and collars Surgery may be necessary, especially to drain
spinal abscesses or debride bony lesions fully or to stabilize the spine.
A 2007 review found only just two randomized clinical trial with at least one year-follow
up found which compared chemotherapy plus surgery with chemotherapy alone for treating
people diagnosed with active tuberculosis of the spine.
As such there is no high grade evidence but the results of this study indicates that surgery
should not be recommended routinely and clinicians have to selectively judge and decide on which
patients to operate.
Thoracic spinal fusion with or without instrumentation as a last resort
Physical therapy for pain-relieving modalties, postural education and teaching a home exercise
program for strength and flexibility Cultural references
The Passionist saint Gemma Galgani suffered from tuberculosis of the spine.
The fictional Hunchback of Notre Dame had a gibbous deformity similar to the type caused
by tuberculosis.
In Henrik Ibsen's play "A Doll's House," Dr. Rank suffers from "consumption of the spine."
Jocelin, the Dean who wanted a spire on his cathedral in William Golding's "The Spire"
probably suffered and died as a result of this disease.
English poets Alexander Pope and William Ernest Henley both suffered from Pott's disease.
Anna Roosevelt Cowles, sister of president Theodore Roosevelt, suffered from Pott's Disease.
Chick Webb, swing era drummer and band leader, was afflicted with tuberculosis of the spine
as a child, which left him hunchbacked.
The Sicilian mafia boss Luciano Leggio had Pott's disease and wore a brace.
Morton, the railroad magnate in Once Upon a Time in the West, suffers from the disease
and needs crutches to walk.
Writer Max Blecher had Pott's Disease.
Marxist thinker and Communist leader Antonio Gramsci suffered from Pott's disease, probably
due to the bad conditions of his incarceration in fascist Italy during the 1930s.
Italian writer, poet and philosopher Giacomo Leopardi suffered from this disease.
It features prominently in the book This Is a Soul, which chronicles the work of American
physician Rick Hodes in Ethiopia.
Imogen in the novella "The Princess with the Golden Hair," part of Memoirs of Hecate County
by Edmund Wilson has Pott's disease.
Jane Addams, social activist and Nobel Peace Prize winner, had Pott's disease.
References
External links Pott Disease — Tuberculous Spondylitis,
eMedicine . "Tuberculous arthritis", MedlinePlus, USA:
NIH . Public domain.
Pott disease Pott's Disease of the Thoracic Spine