Tuberculosis of the Spine (Pott’s Disease)

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Tuberculous spondylitis (Pott’s disease) is a classic presentation of extrapulmonary tuberculosis. It is associated with significant morbidity and can lead to severe functional impairment. 

Cause

  • Mycobacterium tuberculosis

Signs and symptoms

Most common in young adults

  • Localized pain, which increases in severity over weeks to months, sometimes in association with muscle spasm and rigidity
  • Constitutional symptoms such as fever and weight loss are present in < 40% of cases; night sweats and malaise
  • With the progression and spreading of the disease, anterior collapse of affected vertebrae leads to visible deformity (angular kyphosis or gibbus), and risk of cord compression
  • Weakness of legs (paraplegia)
  • Visceral dysfunction

Differential diagnosis

  • Staphylococcal spondylitis
  • Brucellosis
  • Metastatic lesion
  • Sarcoidosis
  • Septic arthritis
  • Vertebral osteomyelitis

Complications

  • Kyphosis
  • Paraplegia
  • Cold abscess
  • Spinal deformity
  • Secondary infection
  • Fatality

Investigations

  • Plain radiograph of the spine: disc space narrowing, paravertebral shadow, single/multiple vertebral involvement, destruction lesions of 2 or more vertebrae without new bone formation, destruction of vertebral end-plates
  • Blood: raised ESR, WBC within normal limits
  • Microbiology studies: AFB using blood tissue or abscess samples.

Management/treatment objectives

  • Eradicate infection
  • Identify and remove the causative agent
  • Recover/maintain neurological function
  • Correct or prevent spinal deformity and possible sequalae
  • Relieve pain

Non- pharmacological management

  • Rest the spine
  • Fit a spinal corset or plaster jacket for pain relief
  • Surgical intervention is warranted for patients in the following circumstances:
    • Patients with spinal disease and advanced neurological deficits
    • Patients with spinal disease and worsening neurological deficits, progressing while on appropriate therapy
    • Patients with spinal disease and kyphosis >40 degrees at the time of presentation
    • Patients with chest wall cold abscess

Pharmacological management/treatment