Potts spine is the classical destruction of disc space and the adjacent bodies , destruction of other spinal elements,severe progressive kyphosis subsequently Also know as spinal tuberculosis

1. POTTS SPINE
Anncy oommen
2nd yr bsc nursing

2. Central objectives
• At the end of lecture, students will be able gain knowledge
about Potts spine and apply nursing process in taking care
of these patients....

3. Specific Objectives
At the end of the class, students will be able to
• Define potts spine.
• List down the predisposing and risk factors of potts spine.
• Explain about pathophysiology of potts spine.
• Elaborate on clinical manifestation and diagnostic findings.
• Discuss about management of potts spine ( medical, surgical,
nursing ).

4. INTRODUCTION
• Described by Percival pott – 1779
• India, one fifth of TB population
• 10% involve skeletal system
• M=F
• Most affected – Lower tboracic and
thoracolumbar region

5. Definition
• The classic destruction of the disk space
and the adjacent bodies, destruction of
other spinal elements ,severe, progressive
kyphosis subsequently.
• It is a combination of osteomyelitis and
arthritis which involve multiple vertebrae.

6. Predisposing
factors...
• Malnutrition
• Poor Sanitation
• Over Crowding
• Close contact witb TB patients
• Immunodeficiency State

7. Risk factors.....
• Older age
• Male gender
• Chronic peritoneal dialysis
• Previous TB infection

8. Types of lesions
• There are four types of involvement of the spinal column have been
described in tuberculosis of spine:-
1. Paradiscal lesion
2. Central body lesion
3. Anterior
4. Posterior

10. Pathogenesis of TB spine
• Step 1:
Bacilli from primary focus through blood stream reach disc shape

11. Cont’d
• Step 2:
Once infected, soft nucleus centre and fibrous
annular wall weakness, decays and collapse.
This caused thr disc to close, squeezing down
on nerve root causing pain.

12. Cont’d
• Step 3:
The infection spreads to vertebral bodies above
and below the disc.

13. Cont’d
• Step 4:
The bone weakened by the infection
collapses under the weight of human body.

14. Cont’d
• Step 5
The deformed spinal column compresses spinal
cord producing functional impairment

15. Cont’d
• Step 6:
Over time, the deformed vertebrae heal and
fuse. This may further compress nerve roots
causing pain and neurological deficit.

16. Clinical Manifestation
• Active stage
Pain – back pain , commonest presenting complaint
Diffuse, radicular pain
Stiffness – very early symptoms, Protective mechanism of the boby
Cold abscess – Pt may present with a swelling ,cold abscess or
problems secondary to compression effects on nearby viscera

17. Cont’d
• Paraplegia – if neglected in early stages
• Deformity
• Constitutional Symptoms – Fever, night sweats, Weight loss
• Healed stage
• No systemic features but deformity persist
• Stiffness
• Deformity
• Restricted ROM
• Neurodeficit

18. Diagnostic
findings
Radiological diagnosis
• Plain radiograph
• CT scan
• MRI
• Bone scan
Biopsy done for confirming the doubtful
diagnosis.

19. Cont’d
Lab studies
• Tuberculin Skin Test demonstrates a +ve finding 84-85% of pt who are
non HIV +ve
• Erythrocyte Sedimentation Rate (ESR) may be markedly elevated
• ELISA has reported senstivity of 60 to 80%
• PCR
• A Brucella Complement Fixation Test

20. Management
Medical Management
The aim of the treatment
• Healing of the disease
• Prevention, early detection &prompt treatmentbl of complication such
as paraplegia.
The other modalities used as follows:-
1. Rest : bed rest- pain relief & to prevent collapse &dislocation of
diseased vertebrae. For cervical spine –minerva jacket and collar.

21. Cont’d
2. Antitubercular treatment
3 phases :- 1) Intensive phase
2) Continuation phase
3) Prophylactic phase
3. Gradual Mobilization :mobilization with suitable spine braces. After 3
to 9wks – back extension exercise for 5 to 10min. Spine braces continude
for 18 months to 2yrs, when it is gradually discarded.
4. Aspiration of abscess :abscess are aspirated when near the surface and
1g of streptomycin with or without INH in soln is instilled at each
aspiration.

22. SURGICAL
MANAGEMENT
Indication for surgery
• Patient with neurological complication
• Progressive bone destruction inspite of ATT
• Failure is respond to conservative therapy
• Evacuation of paravertebral abscess
• Uncertainty of diagnosis, for biopsy
• Mechanical reasons, instability

23. Cont’d
• Prevention of severe kyphosis., in young children
• Large paraspinal abscess
• Spinal tumor syndrome
• Neural disease
• Late onset paraplegia
• Paraplegia of rapid onset or severe paraplegia
Types of Surgery
• Debridement of thr infected material without
stabilization.
• Debridement with stabilization of the spine.

24. Cont’d
Potential benefit of surgery
• Less kyphosis
• Immediate relief of compressed neural tissue
• Quicker relief of pain
• Higher percentage of bony fusion
• Quicker bony fusion
• Less relapse
• Earlier return to previous activities
• Less bone loss
• Prevent neurological prblms due to kyphosis & fibrocis

25. Nursing management
• Acute pain related to inflammatory process
• Impaired physical mobility related to musculoskeletal impairment
secondary to potts paraplegia
• Disturbed body image related to injury progressive destruction in yhe
vertebral column secondary to potts disease
• Risk for impaired skin integrity related to immobility secondary to
spinal cord injury

26. Recapitulation
• Described – percivall pott
• Rare Infectious disease of spine caused by an extraspinal infection
• Bacteria reach the spine via hematogenous spread
• CF: active ( pain, cold abscess deformity, rigidity,rigidity) and healed stage
• Diagnostic : Radiological and lab studies
• Management

27. ASSIGNMENT
• Write about COIN TEST

28. References
• Mayil Vahanan Natarajan, Natarajan Textbook of Orthopedic and
Traumatology 7th edition 2011, Wolter Kluwer India Pvt Ltd New
Delhi ,Page no 53 to 58

29. Poster: pathology of TB SPINE