Tuberculosis (TB) of the spine also known as

Potts disease, Pott’s Caries, David's disease, Tuberculosis spondylitis

and
Pott's curvature
, is the most common site of bone infection in TB. The lower thoracic and upper lumbar
vertebrae are the areas of the spine most often affected. The original name was formed
after
Percivall Pott
, a London surgeon, who first studied the disease. When he died,
Patrick David
was the one who continued his work.Pott’s disease results from haematogenous spread of
tuberculosis (mycobacterium tuberculosis) from other sites. The infection then spreads
from two adjacent vertebrae into the adjoining disc space. If only one vertebra is
affected, the disc is normal,but if two are involved the intervertebral 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. The disease progresses
slowly. Signs and symptoms include: back pain, fever, night sweats, anorexia, weight
loss, and easy fatigability.Diagnosis is based on: blood tests - elevated ESR , skin tests
,radiographs of the spine , bone scan ,CT of the spine , and bone biopsy. Gibbus
formation is the pathognomonic sign of this disease.
A person with Pott's disease often develops kyphosis
, which results in a hunchback. This is often referred to as
Pott’s curvature
. In some cases, a person with Pott's disease may also develop paralysis, referred to as
Pott’s paraplegia
, when the spinal nerves become affected by the curvature. A person who has been
diagnosed with Pott's disease may be treated through a variety of options. He or she may
utilize analgesics or antituberculosis drugs to get the infection under control. It may also
be necessary to immobilize the area of the spine affected by the disease, or the person
may need to undergo surgery in order to drain any abscesses that may have formed or to
stabilize the spine.Since Pott's disease is caused by a bacterial infection, prevention is
possible through proper control. The best method for preventing the disease is reduce or
eliminate the spread of tuberculosis. In addition, testing for tuberculosis is an important
preventative measure, as those who are positive for purified protein derivative (PPD
) can take medication to prevent tuberculosis from forming. A tuberculin skin test is the
most common method used to screen for tuberculosis, though blood tests
, bone scans, bone biopsies, and radiographs may also be used to confirm the disease

The 21 nursing problems are as follows:

1)To maintain good hygiene
2)To promote optimal activity: exercise, rest, and sleep3)To promote safety4)To maintain
good body mechanics.5)To facilitate the maintenance of a supply of oxygen6)To
facilitate maintenance of nutrition7)To facilitate maintenance of elimination8)To
facilitate maintenance of fluid and electrolyte imbalance9)To recognize the physiologic
response of the body to disease conditions10)To facilitate the maintenance of regulatory
mechanisms and functions11)To facilitate the maintenance of sensory function12)To
identify and accept positive and negative expressions, feelings and reactions13)To
identify and accept the interrelatedness of emotions and illness14)To facilitate the
maintenance of effective verbal and non-verbal communication15)To promote the
development of productive interpersonal relationships16)To facilitate progress towards
achievement of personal spiritual goals17)To cerate and maintain a therapeutic
environment18)To facilitate awareness of self as an individual with varying needs19)To
accept the optimum possible goals20)To use community resources as aid in resolving
problems21.To understand the role of social problems as influencing factor

ANATOMY
The vertebral column provides structural support for the trunk and surrounds and protects
the spinal cord. The vertebral column also provides attachment points for the muscles of
the back and ribs. The vertebral disks serve as shock absorbers during activities such as
walking, running, and jumping. They also allow the spine to flex and extend.

MEDICAL/SURGICAL INTERVENTIONS
Management of Pott’s disease
Drug treatment is generally sufficient for Pott’s disease, with spinal immobilization if
required. Surgery is required if there is spinal deformity or neurological signs of spinal
cord compression.Standard antituberculosis treatment
is required. Duration of antituberculosis treatment: If debridement and fusion with bone
grafting are performed, treatment can be for six months. If debridement and fusion with
bone grafting are NOT performed a minimum of 12 months’ treatment is required. It
may also be necessary to immobilize the area of the spine affected by the disease, or the
person may need to undergo surgery in order to drain any abscesses that may have
formed or to stabilize the spine.Other interventions include application of knight/ taylor
brace, head halter traction. Surgery includes ADSF ( Anterior decompression Spinal
fusion).

PATHOPHYSIOLOGY
Pulmonary tuberculosis
Spread of mycobacterium tuberculosis from other
Extrapulmomary tuberculosis
The infection spreads from two adjacent vertebrae into the adjoining disc space
One vertebra is affected, the disc is normalTwo are involved, the avascular intervertebral
disc cannot receive nutrients and collapse
Disk tissue dies and broken down by
caseation
Vertebral narrowing
Vertebral collapse
Spinal damage
Kyphosis, paraplegia, bowel and urinary incontinenece
Surgery: evacuation of pus, Anterior decompression spinal fusion
back pain, fever, night sweats, anorexia, weight loss, and easy
POTT’S DISEASE

Pathophysiology

Pott disease is usually secondary to an extraspinal source of infection. The basic lesion
involved in Pott disease is a combination of osteomyelitis and arthritis that usually
involves more than one vertebra. The anterior aspect of the vertebral body adjacent to the
subchondral plate is area usually affected. Tuberculosis may spread from that area to
adjacent intervertebral disks. In adults, disk disease is secondary to the spread of
infection from the vertebral body. In children, because the disk is vascularized, it can be a
primary site.3

Progressive bone destruction leads to vertebral collapse and kyphosis. The spinal canal
can be narrowed by abscesses, granulation tissue, or direct dural invasion, leading to
spinal cord compression and neurologic deficits. The kyphotic deformity is caused by
collapse in the anterior spine. Lesions in the thoracic spine are more likely to lead to
kyphosis than those in the lumbar spine. A cold abscess can occur if the infection extends
to adjacent ligaments and soft tissues. Abscesses in the lumbar region may descend down
the sheath of the psoas to the femoral trigone region and eventually erode into the skin.

Discharge Plan
Patient should be reminded to attend check-ups at the nearest….O- rthopedic centerT-
reatment should be taken in a…..T- imely mannerS- ight any symptoms other than the
usual and report it to the physician