Pott’s disease or tuberculous spondylitis is when the bacteria of tuberculosis reach the spine from the lungs, and fester. The prevalence of tuberculosis in southeast Asia, and by extension Pott’s disease is high in the region. This disease has potential to cause severe deformities and permanent neurological deficits, unless treatment is timely sought from Best Orthopedic Surgeon in Karachi.
Read on to know more about Pott’s disease:
What causes Pott’s disease?
Pott’s disease begins with the pulmonary or lung infection due to tuberculosis bacteria—known as the mycobacterium tuberculosis. If it is not treated timely, this disease has the potential to spread through the bloodstream to other parts of the body, including the intestines, the brain and the spine.
In the spine, mycobacterium tuberculosis causes spinal arthritis and osteomyelitis or infection of the bone. Usually, more than one vertebra are involved. From the spine, the bug spreads to involve the intervertebral discs and the adjacent vertebra. Eventually there is collapse of the vertebral column and kyphosis.
How does Pott’s disease manifest?
Pott’s disease can present in variable forms—depending on the duration of illness, the overall health of the patient, site of lesion and the presence of concurrent diseases.
In uncomplicated cases, the patient comes to the healthcare provider with severe back pain. If the disease spreads to involve the vertebral column, there may be neurological deficit, instability and kyphosis.
Abscesses are common in Pott’s disease, in the cervical spine, around the vertebrae in thoracic spine and along the paraspinal muscles in the lumbar spine.
Neurological deficit is part of the disease trajectory of complicated spinal tuberculosis. Neurological complication is a sequalae of collapse of the vertebral body leading to compression of tracts coming from the brain or of the tracts going to the brain. There is loss of pain, crude touch and temperature sensations.
Deformity of the spinal column is common when the disease has spread. If there is involvement of the thoracic or lumbar spine, there is a kyphotic orientation to the spinal column. This deformity has the potential to cause neurological complications, if greater than 60 degrees.
How is Pott’s disease diagnosed?
Pott’s disease is diagnosed through blood tests confirming the presence of tuberculosis, followed by radiological investigations, and biopsy. The latter also serves the therapeutic purpose of draining large paraspinal abscesses.
Biopsy is done through percutaneous route through a CT-guided needle. The procedure is safe, and as mentioned before, also helps to drain large abscesses. The sample obtained, is used for pathological and microbiological studies to isolate the organism and confirm the diagnosis.
Open drainage is resorted to in some cases particularly when there is neurological deterioration.
Radiographic studies help to diagnose changes on the plain radiograph like the collapse of vertebrae, destruction of the anterior spine, shadows of enlarged psoas muscle and increase in the angles of vertebrae.
CT scan provides a detailed image of the bone breaking lesions, with disc collapse and sclerosis.
MRI scan is the investigation of choice for evaluation of disc space infection and the extent of osteomyelitis.
What are the treatment options?
According to the British Medical Research Council, the treatment duration of Pott’s disease involves drug chemotherapy for 6 to 9 months. This duration extends to 9 to 12 months in case of complicated illness and major neurological involvement.
The drug regimen as mandated by the US Centers for Disease Control and Prevention (CDC), and the Infectious Diseases Society of America, consists of four-drugs—including the first line agents isoniazid, rifampin, pyrazinamide and ethambutol. During the course of treatment, regular checkups, available for booking at oladoc.com, are mandatory for the patient to monitor for side effects.
