It contains mri and radiological details

1. Pott’s Spine (Spinal Tuberculosis)
Concise Overview for Medical
Students / Interns

2. Definition & Etiology
• • Tuberculous infection of the spine caused by
Mycobacterium tuberculosis
• • Most common form of skeletal tuberculosis
• • Spread via hematogenous route from
primary focus (lungs, lymph nodes)

3. Epidemiology
• • Common in developing countries
• • Affects children and young adults
• • Thoracic spine most commonly involved,
followed by lumbar spine

4. Pathology
• • Starts in cancellous bone of vertebral body
near end plates
• • Caseation and destruction of vertebral body
• • Intervertebral disc involved secondarily
• • Cold abscess formation (paravertebral,
psoas)

5. Commonly Affected Levels
• • Thoracic – most common
• • Lumbar – second most common
• • Cervical – rare but dangerous
• • Sacral – very rare

6. Clinical Features
• • Back pain (earliest and most common
symptom)
• • Constitutional symptoms: fever, weight loss,
night sweats
• • Local tenderness and stiffness
• • Gibbus deformity (sharp kyphosis)
• • Neurological deficits (paraplegia)

7. Cold Abscess
• • Formed due to liquefaction of caseous
material
• • Non-inflammatory, painless swelling
• • Common sites: paravertebral, psoas (may
present in groin)

8. Neurological Complications
• • Pott’s paraplegia
• • Causes:
• – Mechanical compression by
abscess/granulation tissue
• – Vertebral collapse and kyphosis
• – Spinal cord edema or infarction

9. Investigations
• • X-ray spine: reduced disc space, vertebral
collapse, kyphosis
• • MRI: investigation of choice – cord
compression, abscess
• • ESR raised
• • CBNAAT / biopsy for confirmation

10. Differential Diagnosis
• • Pyogenic spondylodiscitis
• • Metastatic spine disease
• • Multiple myeloma
• • Brucellosis

11. Management
• • Anti-tubercular therapy (ATT) – mainstay
• • Duration: 12–18 months (as per guidelines)
• • Immobilization and rest
• • Surgical decompression indicated in:
• – Progressive neurological deficit
• – Severe deformity or instability
• – Non-responding cases

12. Complications
• • Kyphotic deformity
• • Pott’s paraplegia
• • Chronic pain and disability
• • Residual neurological deficit

13. Radiological Findings – X-ray
• • Earliest sign: narrowing of intervertebral disc
space
• • Osteoporosis of affected vertebrae
• • Lytic lesions in vertebral body
• • Anterior wedging and vertebral collapse
• • Angular kyphosis (Gibbus deformity)
• • Paravertebral shadow due to cold abscess

14. MRI Findings (Investigation of
Choice)
• • Hypointense vertebral body on T1-weighted
images
• • Hyperintense signal on T2-weighted images
• • Disc involvement with end plate destruction
• • Paravertebral and epidural abscess
• • Spinal cord compression and edema
• • Helps differentiate TB from malignancy

15. CT Scan Findings
• • Better visualization of bony destruction
• • Sequestrum and cortical breach
• • Guides biopsy and surgical planning