POTTS DISEASE

Mary Katleene D. Cueto

 Pott's

disease is tuberculosis of the spinal column named after Percival Pott (1714-1788) usual sites: lower thoracic and upper lumbar vertebrae. often spread from the lungs via the blood a combination of osteomyelitis and infective arthritis.

*In adults, disc disease is secondary to the spread of infection from the vertebral body but in children it can be a primary site, as the disc is vascular in children. if two vertebra are involved the disc between them collapses as it is avascular and cannot receive nutrients Caseation occurs, with vertebral narrowing and eventually vertebral collapse and spinal damage. A dry soft tissue mass often forms and superinfection is rare.

ETIOLOGY
Mycobacterium

Tuberculosis

EPIDEMIOLOGY
African

Americans Hispanic Americans Asian Americans male to female ratio is reportedly 1.52:1. Young adults Adults 1-2% of TB cases

RISK FACTORS
Endemic

tuberculosis. Poor socio-economic conditions. HIV infection

ASSESSMENT
The onset is gradual. Back pain is localized. Fever, night sweats, anorexia and weight loss. Signs may include kyphosis (common) and/or a paravertebral swelling. Affected patients tend to assume a protective upright, stiff position. If there is neural involvement there will be neurological signs. **Asymptomatic Presentation

PATHOGNOMONIC SIGN

PROGNOSIS
The

progress is slow and lasts for months or even years. Prognosis is better if caught early and modern regimes of chemotherapy are more effective. A study from London showed that diagnosis can be difficult and is often late

COMPLICATIONS
Progressive

bone destruction leads to vertebral collapse and kyphosis: The spinal canal can be narrowed by abscesses, granulation tissue, or direct dural invasion. Kyphosis occurs because of collapse in the anterior spine and can be severe. Neurological problems can be prevented by early diagnosis and prompt treatment. It can reverse paralysis and minimize disability.

Late onset paraplegia is best avoided by prevention of the development of severe kyphosis. Patients with tuberculosis of the spine who are likely to have severe kyphosis should have surgery in the active stage of disease. o A cold abscess can occur if the infection extends to adjacent ligaments and soft tissues.

WORKUP
The Mantoux Test (Tuberculin Skin Test) Erythrocyte Sedimentation Rate (ESR) Microbiology Studies Radiography CT Scanning MRI Biopsy Polymerase Chain Reaction (PCR)

TREATMENT
Pharmacological

Isoniazid

(Laniazid, Nydrazid) Rifampin (Rifadin, Rimactane) Pyrazinamide Ethambutol (Myambutol) Streptomycin

TREATMENT
Surgical

spinal fusion or spinal decompression

Alternative

Currently there are no alternative managements of Pott's disease from evidence based sources

ACTIVITY RESTRICTIONS

Immobilization of the spine is usually for 2 or 3 months.

DIET
PROTEIN INTAKE To build new tissues that support bones damaged by tuberculosis VITAMIN INTAKE Vitamin D aids in calcium absorption.

PATIENT HT
P- atient should be reminded to attend checkups at the nearest. O- rthopedic center T- reatment should be taken in a T- imely manner S- ight any symptoms other than the usual and report it to thephysician