Pott's disease, also known as tuberculous spondylitis, is a form of extrapulmonary tuberculosis that affects the spine. It is caused by the bacterium Mycobacterium tuberculosis spreading from other sites, often the lungs, to the vertebrae via the bloodstream. This can cause the vertebrae to soften and collapse, resulting in kyphosis or spinal curvature. If left untreated, it can lead to complications like vertebral collapse, spinal cord compression, or paraplegia. Diagnosis involves blood tests, tuberculin skin tests, imaging scans of the spine, and biopsies. Treatment focuses on antibiotics, bed rest, spinal immobilization, surgery if needed

1. Pott’s Disease / Tuberculosis of Spine
Pott’s disease is caused when the vertebrae become soft and collapse as the result of caries or osteitis. Typically, this is caused by
mycobacterium tuberculosis. As a result, a person with Pott's disease often develops kyphosis, which results in a hunchback. This is often
referred to as Pott’s curvature. In some cases, a person with Pott's disease may also develop paralysis, referred to as Pott’s paraplegia, when
the spinal nerves become affected by the curvature.
It is named after Percivall Pott a British surgeon.The lower thoracic and upper lumbar vertebrae are the areas of the spine most often affected.
It is not to be confused with Postural orthostatic tachycardia syndrome, also known as "POTS".
Pott's disease is a presentation of extrapulmonary tuberculosis that affects the spine, a kind of tuberculous arthritis of the intervertebral joints.
More precisely it is called tuberculous spondylitis.Pott’s disease results from haematogenous spread of tuberculosis from other sites, often
pulmonary. The infection then spreads from two adjacent vertebrae into the adjoining disc space. If only one vertebra is affected, the disc is
normal, but if two are involved theintervertebral disc, which is avascular, cannot receive nutrients and collapses. The disc tissue dies and is
broken down by caseation, leading to vertebral narrowing and eventually to vertebral collapse and spinal damage). A dry soft tissue mass often
forms and superinfection is rare.
ETIOLOGY of Tuberculosis of Spine
• Causative organism: Mycobacterium tuberculosis.
• Spread: Haematogenous. (by blood)
• Commonly associated with: Debilitating diseases, AIDS, Drug addiction, Alcoholism.
Symptoms of Tuberculosis of Spine
Symptoms
The onset is gradual.
• Back pain is localised.
• Restricted spinal movements.
• Fever.
• Night sweats.
• Anorexia.
• Weight loss.
Signs
• There may be kyphosis. (spinal curvature)
• Muscle wasting.
• A paravertebral swelling may be seen (spinal mass).
• They tend to assume a protective upright, stiff position (pain).
• If there is neural involvement there will be neurological signs (tingling, numbness, or feeling of weakness in the leg muscles).
• A psoas abscess (may present as a lump in the groin and resemble a hernia).
Differential diagnosis
• Pyogenic osteitis of the spine.
• Spinal tumours.
INVESTIGATION for Tuberculosis of Spine
Blood

2. • TLC: Leucocytosis.
• ESR: raised >100 mm/h
Tuberculin skin test(purified protein derivative [PPD])
• positive.
Aspirate from joint space & abscess
• Transparency: turbid.
• Colour: creamy.
• Consistency: cheesy.
• WBC: 25000/cc.mm.
Histology
• Shows granulomatous tubercle.
X-Ray spine
• Narrowed joint space.
• shadow of abscess in soft tissue.
• Destruction of bone.
• Wedge-shaped deformity (collapse of vertebrae anteriorly).
Bone scan
CT of the spine
Bone biopsy
MRI
GENERAL MANAGEMENT for Pott's Disease
• Bed rest.
• Immobilisation of affected joint by splintage.
• Nutritious, high protein diet.
• Drainage of abscess.
• Surgical decompression.
Physiotherap
Non-operative – antituberculous drugs
Analgesics
Immobilization of the spine region different types of braces and collars
Surgery may be necessary, especially to drain spinal abscesses or debride bony lesions fully or to stabilize the spine.
Physical therapy for pain-relieving modalties, postural education and teaching a home exercise program for strength and flexibility
Complications
• Vertebral collapse resulting in kyphosis.
• Spinal cord compression.

3. • Sinus formation.
• Paraplegia (so called Pott's paraplegia).
PREVENTION
Controlling the spread of tuberculosis infection can prevent tuberculous spondylitis and arthritis. Patients who have a positive PPD test (but not
active tuberculosis) may decrease their risk by properly taking medicines to prevent tuberculosis. To effectively treat tuberculosis, it is crucial
that patients take their medicati ons exactly as prescribed.