Pott's disease
- Pott's disease is tuberculous spondylitis
- Well recognised in Egyptian mummies
- Described by Percival Pott in 1779
- Now rare in western countries
- Still prevalent in the developing world
Pathology
- Usually occurs secondary to infection elsewhere
- Due to a combination of osteomyelitis and arthritis
- Often occurs at more than one vertebral level
- Usually affects anterior part of vertebral body
- More common in thoracic spine
- Bone destruction lead to vertebral collapse and kyphosis
- Spinal cord can be narrowed resulting in cord compression and
neurological deficit
Clinical presentation
- Back pain is the commonest symptom
- Pain may be present for several months
- Pain can be both spinal and radicular
- 50% patients have neurological signs at presentation
- Most patients have some degree of kyphosis
- Cold abscess may point in the groin
Investigations
- Serum ESR is usually massively raised
- Tuberculin skin test is usually positive
- Plain x-rays may show
- Lytic destruction of anterior vertebral body
- Anterior vertebral collapse
- Reactive sclerosis
- Enlarged psoas shadow
- CT or MRI provides information on disc space and neurological
involvement
- As allows CT guided biopsy to obtain microbiological and
pathological specimens
Picture provided by Christine Breynoert, Hospital
Saint-Elizabeth, Zottegen, Belgium
Treatment
- Treatment involves both tuberculous chemotherapy and possible
surgery
- Nine months of combination chemotherapy should be used
- This involves 3 or 4 drugs
- Isoniazid and rifampicin should be given for full nine months
- Pyrazinamide, ethambutol or streptomycin should be give for first 2
months
- Surgery is indicated if:
- Neurological deficit
- Spinal deformity with instability
- No response to medical treatment
- Non-diagnostic percutaneous biopsy
- Surgical approach depends on extent of disease and level of spinal
involvement
- Usually involves radical debridement and posterior stabilisation
Bibliography
Almeida A. Tuberculosis of the spine and spinal cord.
Eur J Radiol 2005; 55: 193-201.
Busteed S, Beeching N J, Nye F J et al. Tuberculous
osteomyelitis: chasing the elusive tubercle. Hosp Med
2004; 65: 438-439.
Moore S L, Rafii M. Imaging of musculoskeletal and spinal
tuberculosis. Radiol Clin North Am 2001; 39:
329-342. |