INTRODUCTION

Tuberculosis (TB) of the spine also known as Potts disease, Pott’s Caries, David's disease,
Tuberculosis spondylitis and Pott's curvature, is the most common site of bone infection in TB.
The lower thoracic and upper lumbar vertebrae are the areas of the spine most often affected.
The original name was formed after Percivall Pott, a London surgeon, who first studied the
disease. When he died, Patrick David was the one who continued his work.

Pott’s disease results from haematogenous spread of tuberculosis (mycobacterium

tuberculosis) from other sites. 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
the intervertebral 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.

The disease progresses slowly.  Signs and symptoms include: back pain, fever, night
sweats, anorexia, weight loss, and easy fatigability.

Diagnosis is based on: blood tests - elevated ESR , skin tests ,radiographs of the spine ,
bone scan ,CT of the spine , and bone biopsy. Gibbus formation is the pathognomonic sign of
this disease.

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.

A person who has been diagnosed with Pott's disease may be treated through a variety
of options. He or she may utilize analgesics or antituberculosis drugs to get the infection under
control. 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.

Since Pott's disease is caused by a bacterial infection, prevention is possible through proper
control. The best method for preventing the disease is to reduce or eliminate the spread of
tuberculosis. In addition, testing for tuberculosis is an important preventative measure, as those
who are positive for purified protein derivative (PPD) can take medication to prevent
tuberculosis from forming. A tuberculin skin test is the most common method used to screen for
tuberculosis, though blood tests, bone scans, bone biopsies, and radiographs may also be used
to confirm the disease
normal

Pott’s disease

Pathophysiology

Pott disease is usually secondary to an extraspinal source of infection. The basic lesion involved
in Pott disease is a combination of osteomyelitis and arthritis that usually involves more than
one vertebra. The anterior aspect of the vertebral body adjacent to the subchondral plate is area
usually affected. Tuberculosis may spread from that area to adjacent intervertebral disks. In
adults, disk disease is secondary to the spread of infection from the vertebral body. In children,
because the disk is vascularized, it can be a primary site.

Progressive bone destruction leads to vertebral collapse and kyphosis. The spinal canal can be
narrowed by abscesses, granulation tissue, or direct dural invasion, leading to spinal cord
compression and neurologic deficits. The kyphotic deformity is caused by collapse in the
anterior spine. Lesions in the thoracic spine are more likely to lead to kyphosis than those in the
lumbar spine. A cold abscess can occur if the infection extends to adjacent ligaments and soft
tissues. Abscesses in the lumbar region may descend down the sheath of the psoas to the
femoral trigone region and eventually erode into the skin
 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 incontinence

Surgery: evacuation of pus, Anterior decompression spinal fusion

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).

 anti-TB drugs
 treatment for TB patient
 Jewet and Taylor brace
 Head halter traction
Saint Michael’s College of Laguna
Old National Road, Platero, Biñan, Laguna
School of Nursing and Midwifery

Submitted by: Lara Jean S. Renido

BSN IV-B Group 7