Tb of the spine or Pott’s disease is apresentation of extrapulmonarytuberculosis that affects the spine, a kind of tuberculous arthritis of theintervertebral joints. The lower thoracic and upper lumbarvertebrae are the areas of the spine mostoften affected. Scientifically, it is called tuberculousspondylitis
Pott’s disease results from haematogenousspread of tuberculosis from other sites, oftenpulmonary. The infection then spreads from two adjacentvertebrae into the adjoining intervetebral discspace. If only one vertebra is affected, the disc isnormal, but if two are involved, the disc, whichis avascular, cannot receive nutrients andcollapses. The disc tissue dies leading to intervertebralspace narrowing and eventually to vertebralcollapse and spinal damage.
Incidence In the United States, bone and softtissue tuberculosis accounts forapproximately 10% of extrapulmonaryTB cases and between 1% and 2% oftotal cases. Of these cases, Pott’s disease is themost common manifestation ofmusculoskeletal TB, accounting forapproximately 40-50%.
EthnicityData from the United States show thatmusculoskeletal tuberculosis primarilyaffects African Americans, HispanicAmericans, Asian Americans, andforeign-born individuals.
GenderAlthough some studies have found thatPott’s disease does not have sexualpredilection, the disease is morecommon in males. The male to female ratio is reportedly1.5-2:1.
AgeIn the United States and otherdeveloped countries, Pott’s diseaseoccurs primarily in adults. In underdeveloped countries which havehigher rates of Pott’s disease,involvement in young adults and olderchildren predominates.
back pain Fever Tenderness on furrow of the back night sweating anorexia Spinal mass, sometimes associated withnumbness, paraesthesia, or muscleweakness of the legs Restriction of spinal movements
blood tests elevated erythrocyte sedimentation rate>100 mm/h Mantoux test results are positive in 84-95% of patients with Pott disease whoare not infected with HIV.
radiographs of the spine: Radiographic changes associated withPott’s disease present relatively late. Lytic destruction of anterior portion ofvertebral body Increased anterior wedging Collapse of vertebral body Reactive sclerosis on a progressive lyticprocess Enlarged psoas shadow with or withoutcalcification
bone scan CT of the spine bone biopsy MRI
The medical management is mainlyfocused to eliminate the infection andpain suppression antituberculous drugs(rifampicin,isoniazid,pyrazinamide,ethambutol andstreptomycin Analgesics(pethidine,diclofenac)
Surgery may be necessary, especially todrain spinal abscesses or to stabilize thespine Thoracic spinal fusion is done as a lastresort
Excersizes focusing on muscles of theback can strenghthen them preventingfurther kyphosis Electrotherapy modalities are usefull inalleviating pain
Since physio mx is mainly focused onpain and muscle strength it can’t : Reverse the bone destruction that takesplace The necrosis that would have occurredto ivds stop the progression of the diseases
Modalities like ift can’t be used directlyon the vertebral column hence its effectsare not maxmal Continued exercesizes might give amuslce cast in the deformed position
Prognosis is variable, some individuals willrecover completely,particularly if theinfection has been cured. Those requiring longterm suppressivetherapy may develop recurrences if drugtherapy is not maintained Although spinal fusion maybe effective inrelieving pain discomfort depending on theseverity of the symptoms, surgery will nothowever treat the underlying disease
In the past prior to discovery of drugs forTb, 20% of patients died and 30% hadrecurrence of their symptoms.