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Pott's Disease - Causes, Symptoms, Diagnosis and Treatment

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Pott disease is tuberculosis of the spine due to spread from other sites through the blood to the spine's lower thoracic and upper lumbar vertebrae.

Written by

Dr. Geethika. B

Medically reviewed by

Dr. N. Ashok Viswanath

Published At June 24, 2022
Reviewed AtJuly 16, 2023

What Is Pott's Disease?

Pott's disease is also known as tuberculosis spondylitis or spinal tuberculosis. It is a rare infectious disease of the spine that is typically caused by a tuberculosis infection from another site. This disease presents as a combination of osteomyelitis and arthritis involving multiple vertebrae. It typically involves the anterior part of the vertebral body and occurs most frequently involving the lower thoracic vertebrae. This disease causes vertebral collapse, and when it occurs anteriorly, the anterior wedging leads to a deformity of the spine known as kyphosis (hunched back). The other effects include compression fractures, deformities of the spine, and neurological manifestations, including paraplegia. The disease was named after the person who discovered the condition in the 1700s, Dr. Percivall Pott.

What Causes Pott's Disease?

Tuberculosis is caused by the infectious bacteria Mycobacterium tuberculosis, which primarily affects the lungs. If timely treatment is not provided, it may quickly progress to the spine and cause arthritis. When the infection spreads to two adjacent joints and treatment is not given, it can result in deterioration as the spinal disc receives fewer nutrients.

The disc collapse leads to damage to the spinal cord. If treatment is not given, it results in damage to nerves, paralysis, and deformities of the spine. Only one to two percent of patients develop Pott's disease after contracting pulmonary (lung) tuberculosis.

What Are the Symptoms of Pott's Disease?

The lower thoracic vertebrae are the most commonly involved (40% to 50%), followed by the lumbar vertebra (35% to 45%), cervical spine (10%), and atlantoaxial region (1%).

Primary Symptoms:

  • Tenderness and pain in the affected region.

  • Spasm of the associated muscles.

  • The spinal motion may become restricted.

  • Deformity of the spine.

  • Neurological defects.

The first and foremost symptom of Pott disease is back pain. The back pain lasts for weeks, if not months before the patient seeks treatment and presents as either spinal or radicular pain. The thoracic and lumbar spinal areas are affected almost equally, involving 80% to 90% of spinal tuberculosis sites. However, the thoracic area of the spine is more frequently reported as the common site of involvement.

Neurologic defects occur in about 50% of cases and include compression of the spinal cord accompanied by:

  • Impaired sensation.

  • Paraplegia.

  • Nerve root pain.

  • Cauda equina syndrome.

  • Paresis.

Spinal deformity is seen in almost all patients with Pott's disease. The most common spinal deformity is thoracic kyphosis.

Other Associated Symptoms:

  • Fever.

  • Weight loss.

  • Night sweats.

  • Malaise.

The less common variant, cervical spine tuberculosis, occurs in approximately 10% of cases. However, this variant is relatively more severe because of the severe neurological complications, cervical pain and stiffness, torticollis, and hoarseness. In upper cervical spine involvement, the symptoms are rapidly progressive and may occur early. The neurologic manifestations range from a single nerve palsy to hemiparesis or quadriplegia accompanied by a retropharyngeal abscess. In lower cervical spine injuries, the patient can present with dysphagia or stridor.

Pott's Disease in People With HIV Infection:

Spinal tuberculosis is more common in people infected with the human immunodeficiency virus (HIV), and the clinical presentation is similar to that of HIV negative population.

Asymptomatic Population:

Pott's disease is asymptomatic in 62% to 90% of the population with the disease and shows no evidence of extraspinal tuberculosis as well. This complicates timely diagnosis and worsens the prognosis.

How Is Pott's Disease Diagnosed?

The following tests aid in the diagnosis of Pott's disease:

1) The Tuberculin Skin Test (Mantoux Test):

It is a skin test that is used to diagnose tuberculosis that involves the injection of a purified protein derivative (PPD).

2) Erythrocyte Sedimentation Rate (ESR):

The erythrocyte sedimentation rate may be markedly increased (greater than 100 mm/h).

3) Bacterial Isolation:

The samples are collected from bone tissue to stain for acid-fast bacilli (AFB). The organisms are then isolated for culture and tested for susceptibility. However, the samples tested positive for the organism in only about 50% of the cases.

4) Radiographic Changes:

The radiographic changes are usually present much later compared to the other symptoms. On plain radiography, the following changes can be noted:

  • Lytic destruction of the anterior portion of the vertebral body.

  • Reactive sclerosis on a progressive lytic process.

  • Increased anterior wedging.

  • The collapse of the vertebral body.

  • Vertebral endplates may be osteoporotic.

  • Enlarged psoas shadow with or without calcification.

  • Vertebral bodies show variable degrees of destruction.

  • Intervertebral disks may be shrunk or destroyed.

  • Bone lesions may occur at more than one level.

  • Fusiform paravertebral shadows suggest abscess formation.

5) Computed Tomography (CT) Scanning:

CT scanning with low contrast resolution provides a better assessment of the epidural and paraspinal soft tissues. CT scan also shows bony detail of disk collapse, irregular lytic lesions, disruption of bone circumference, and sclerosis.

6) Magnetic Resonance Imaging (MRI):

Disk-space infections, neural compression, tuberculosis spondylitis (differentiates from pyogenic spondylitis), and spinal osteomyelitis are best diagnosed by MRI, as it is the gold standard criterion. It is the most effective for demonstrating the extension of tuberculosis into the soft tissue space. It also demonstrates the spread of tuberculosis under the anterior and posterior longitudinal ligaments.

7) Biopsy:

A CT-guided needle biopsy can be used to drain large paraspinal abscesses and obtain tissue samples from bone lesions.

8) Polymerase Chain Reaction (PCR):

PCR techniques rapidly detect and diagnose several strains of Mycobacterium without the need for prolonged culture and are used to identify discrete genetic mutations in deoxyribonucleic acid (DNA) sequences associated with drug resistance.

How Is Pott's Disease Treated?

The treatment of Pott's disease varies for each individual and is based on the doctor's discretion. The course of treatment is usually from six months to one year. The medications prescribed aim at inhibiting the growth and proliferation of Mycobacterium tuberculosis. The first line of drugs is Isoniazid and Rifampin. These drugs are administered throughout the course of treatment. Other drugs that may be given during the first two months of treatment are Pyrazinamide, Ethambutol, and Streptomycin. If there is drug resistance, the second line of drugs is avoided. Although pharmacologic treatment is effective, certain cases require surgical management to prevent further progression of the disease and to correct any deformities.

Conclusion:

The progress of the disease is often slow and persists for months or years. Prognosis is better if the symptoms are noted early and the latest regimes of drugs are administered. However, the symptoms are often identified at a later stage. Preventive measures like getting the BCG (bacillus Calmette-Guerin) vaccine are ideal for people who are at high risk.

Frequently Asked Questions

1.

What Is Potts Disease Caused By?

Potts disease is an extension of tuberculosis infection caused by the bacteria Mycobacterium tuberculosis. When the initial lung disease caused by this bacteria is not treated on time, the infection will spread through the blood and infest the spine. The disease may progress to arthritis, intervertebral disc collapse, and spinal deformity.

2.

What Are the Signs and Symptoms of Potts Disease?

The clinical features of Pott’s disease include,
 - Tenderness at the site.
 - Muscle spasm. 
 - Restricted spinal motion. 
 - Deformity of the spine. 
 - Neurological defects.
Back pain is the major problem the patients may complain of. Other symptoms like fever, malaise, night sweats, and weight loss may be present.

3.

Is Potts Disease Serious?

Yes, Pott’s disease is severe since it affects the spine (commonly the lower thoracic and upper lumbar) and is progressive without treatment. The complications are spinal bone destruction, deformity, nerve damage, and paraplegia (unable to move voluntarily).

4.

Is Pott Disease Contagious?

Yes. Potts disease is a musculoskeletal form of tuberculosis infection and is contagious. The active tuberculosis infection can spread from one person to the other through air-borne droplets during coughing, sneezing, and talking. The spread can happen even if the patient is asymptomatic.

5.

Is Spinal TB Life-Threatening?

The occurrence of Pott’s disease is very rare. Only about one to two percent of the population get Pott’s disease after contracting the tuberculosis lung infection. But once diagnosed, it can be life-threatening. The treatment outcome is good if the symptoms are identified, and the infection is treated earlier.

6.

How Do You Get Pott’s Disease?

A contagious bacteria, Mycobacterium tuberculosis, cause Pott’s disease. One can acquire the bacteria by close contact with the infected person. The infection spreads through respiratory droplets, and the lungs are affected initially. If not treated, the disease spreads to the spinal columns and causes Pott’s disease.

7.

What Happens with Pott’s Disease?

In Pott’s disease, the tuberculosis infection from the lungs spreads to the spinal bone, causing arthritis (inflammation). If not treated on time, the disease may progress to the space between the joints and cause intervertebral disc deterioration. Further, the disc may collapse, causing damage to the nerves and the spinal cord.

8.

Can Pott’s Disease Be Cured?

The treatment goal of Pott’s disease is initially controlling the bacterial infection and stopping the progress of the disease. Rigorous medication regimens can achieve this. Surgery may be needed in the advanced stage to correct spinal deformities and neurological defects. The treatment outcome is generally reasonable.

9.

What Are the Risk Factors for Pott’s Disease?

Generally, the risk factors for acquiring tuberculosis infection are HIV (human immunodeficiency virus) infection, smoking, alcohol, and rug abuse (since these are involved in the suppression of the immune system). Other social factors like poverty, malnutrition, crowded places, and poor social situation can increase the risk of tuberculosis.

10.

What Is the First Stage of Pott’s Paraplegia?

Pott’s paraplegia with spinal involvement was classified into five stages, demonstrated by modified Tuli classification. It is the most applicable classification of Pott paraplegia with spinal cord involvement. The first stage is when the deficit is only detectable on the physical examination by the clinician.

11.

What Is the Most Common Spinal Deformity of Pott’s Disease?

Most patients with Pott’s disease exhibit spinal deformity. Kyphosis is the most common spinal deformity involving the thoracic vertebrae. Kyphosis means the forward rotating of the spine; its severity depends on the number of spinal bones involved.

12.

Which Complication Is Associated with Pott Disease?

Untreated Pott’s disease can lead to severe complications and can be a cause of death. Sometimes, the treatments might fail to improve the symptoms because of the disease severity and the patient's compliance with therapy. Neurological defects, abscesses (painful pus formation), spinal deformity, and instability are the common complications associated with Pott’s disease.

13.

What Is Pott’s Disease Prognosis?

The progress of Pott’s disease is generally slow and can be asymptomatic during the initial days. The disease persists for months and even for years. The prognosis is better on early diagnosis and with the administration of the latest drug regimens. However, the symptoms are often identified at a later stage.
Dr. N. Ashok Viswanath
Dr. N. Ashok Viswanath

Infectious Diseases

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