Pott's Disease

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Pott’s Disease aka tuberculous spondylitis is a type of vertebral osteomyelitis caused by tuberculosis. Since the advent of antituberculosis agents, it has become rare in developing countries. The anterior aspect of the vertebral body adjacent to the subchondral plate is usually affected, most commonly in the thoracic spine (40-50%). A psoas abscess (often calcified) and subligamentous spread can also be found. Untreated disease leads to vertebral compression fracture, kyphosis and possible spinal cord compression.

  • Diagnosis
    • Pain usually mild, indolent course
    • ESR markedly elevated (can be normal)
    • PPD usually positive (may be nonreactive in immunocompromised patients)
    • Imaging: MRI with contrast test of choice.
      • Spares disc space (pathognomonic).
      • Vertebral destruction out of proportion to pain
    • Percutaneous CT guided needle biopsy with acid fast stain may be helpful
  • Treatment: 4-drug antituberculosis therapy. At least 9 – 12 months of isoniazid and rifampin. In addition, patients should also receive pyrazinamide and ethambutol (streptomycin is an alternative) for first 2 months of therapy.
    • Surgical indications include an acute neurological deficit, spine instability, no response to medical therapy, large paraspinal abscess and nondiagnostic percutaneous needle biopsy sample.

References

Park DW, Sohn JW, Kim EH, et al. Outcome and management of spinal tuberculosis according to the severity of disease: a retrospective study of 137 adult patients at Korean teaching hospitals. Spine. Feb 15 2007;32(4):E130-5.

Moorthy S, Prabhu NK. Spectrum of MR imaging findings in spinal tuberculosis. AJR Am J Roentgenol. Oct 2002;179(4):979-83.

Watts HG, Lifeso RM. Tuberculosis of bones and joints. J Bone Joint Surg Am. Feb 1996;78(2):288-98.

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