-Tuberculosis (TB) of the spine (Pott’s disease) is the most common site of bone
infection in TB; hips and knees are also often affected. The lower thoracic and upper
lumbar vertebrae are the areas of the spine most often affected.
-Partial destruction of the vertebral bones, usually caused by a tuberculous
infection and often producing curvature of the spine.
Common cause or etiology of Pott’s disease
• Causative organism: Mycobacterium tuberculosis.
• Spread: Haematogenous. (by blood)
• Commonly associated with: Debilitating diseases, AIDS, Drug addiction,
Alcoholism.
S/S: 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.
• They tend to assume a protective upright, stiff position.
• If there is neural involvement there will be neurological signs.
• A psoas abscess (may present as a lump in the groin and resemble a
hernia).
Anatomy and Physiology
The vertebral column provides structural support for the trunk and surrounds and
protects the spinal cord. The vertebral column also provides attachment points
for the muscles of the back and ribs. The vertebral disks serve as shock
absorbers during activities such as walking, running, and jumping. They also
allow the spine to flex and extend.
PATHOPHYSIOLOGY
Pulmonary tuberculosis
Spread of mycobacterium tuberculosis from other site
Extrapulmomary tuberculosis
The infection spreads from two adjacent vertebrae into the adjoining disc space
back pain, fever, night sweats, anorexia, weight loss, and easy fatigability.
One vertebra is affected, the disc is normal
Two are involved, the avascular intervertebral disc cannot receive nutrients and collapse
Disk tissue dies and broken down by caseation
Vertebral narrowing
Vertebral collapse
Spinal damage
POTT’S DISEASE
Kyphosis, paraplegia, bowel and urinary incontinenece
Surgery: evacuation of pus, Anterior decompression spinal fusion
Blood
• TLC: Leucocytosis.
• ESR: raised during acute stage.
Tuberculin skin test
• Strongly positive.
• Negative test does not exclude diagnosis.
Aspirate from joint space & abscess
• Transparency: turbid.
• Colour: creamy.
• Consistency: cheesy.
• Fibrin clot: large.
• Mucin clot: poor.
• WBC: 25000/cc.mm.
Histology
• Shows granulomatous tubercle.
X-Ray spine
Early:-
• Narrowed joint space.
• Diffuse vertebral osteoporosis adjacent to joint.
• Erosion of bone.
• Fusiform paraspinal shadow of abscess in soft tissue.
Late:-
• Destruction of bone.
• Wedge-shaped deformity (collapse of vertebrae anteriorly).
• Bony ankylosis.
Complications
• Vertebral collapse resulting in kyphosis.
• Spinal cord compression.
• Sinus formation.
• Paraplegia (so called Pott's paraplegia).
MEDICAL/SURGICAL INTERVENTIONS
Management of Pott’s disease
Drug treatment is generally sufficient for Pott’s disease, with spinal immobilization if required. Surgery is
required if there is spinal deformity or neurological signs of spinal cord compression.
Standard antituberculosis treatment is required. Duration of antituberculosis treatment: If debridement and
fusion with bone grafting are performed, treatment can be for six months. If debridement and fusion with
bone grafting are NOT performed a minimum of 12 months’ treatment is required.
It may also be necessary to immobilize the area of the spine affected by the disease, or the person may
need to undergo surgery in order to drain any abscesses that may have formed or to stabilize the spine.
Other interventions include application of knight/ taylor brace, head halter traction. Surgery includes ADSF (
Anterior decompression Spinal fusion).
GENERAL MANAGEMENT/Nursing intervention for Pott's Disease
• Bed rest.
• Immobilisation of affected joint by splintage.
• Nutritious, high protein diet.
• Drainage of abscess.
• Surgical decompression.
• Physiotherapy.
