Pott’s Spine - An Overview

Introduction

Pott’s spine is spinal tuberculosis, which causes spinal infection usually caused by tuberculosis, which results in osteomyelitis, spinal mechanical instability, or kyphotic deformity. The spine is the common location where musculoskeletal tuberculosis occurs. The common symptoms of spine tuberculosis are back pain, kyphotic deformity, weakness in the lower limb, and paraplegia.

Recently, this condition has been seen more in developed nations, usually in the immunosuppressed population. There is an increase in the occurrence of multidrug-resistant bacterial strains of tuberculosis, usually in developed nations.

What Is Meant by Spinal Tuberculosis?

Pott’s disease is also called spinal tuberculosis, which is an infection that affects the spine. The lower thoracic and upper lumbar regions are the most affected parts of the spine. The source of infection is generally from the outside of the spine. The infection usually spreads from the lungs through the blood. Tuberculosis of the spine is a combination of osteomyelitis and infective arthritis. Generally, only one vertebra is affected, and the anterior portion of the vertebral body is most commonly involved. Tuberculosis usually spreads from the affected area to the spine.

The spine is the common region of the skeletal system to be affected by tuberculosis, even though hips and knees could get affected. The infection usually spreads from the adjacent vertebrae into the disc spaces. If one vertebra is affected by the infection, the disc seems normal, but if two vertebrae are affected, the disc collapses due to a lack of nutrients.

What Is the Epidemiology of Pott’s Spine?

Pott’s spine is the most common infection of the spine seen in countries where tuberculosis is prevalent. The occurrence of Pott disease is on the rise when compared to other forms of tuberculosis due to multiple drug-resistant strains. Osteomyelitis comprises 50 percent of musculoskeletal tuberculosis that usually affects the spine at the lower thoracic and upper lumbar levels.

What Are the Symptoms Related to Pott’s Spine?

Usually, people affected by Pott’s spine will have an insidious history of back pain, and the thoracic vertebrae get affected with a pattern of bone destruction along with disc preservation and masses present in the paravertebral and epidural soft tissues.

The common symptoms are:

• The onset of the infection is very gradual.

• Localized back pain.

• Presence of fever, night sweats, anorexia, and weight loss.

• The presence of kyphosis (exaggerated forward rounding of the upper back region), or paravertebral swelling, is common.

• The affected person will assume an upright, stiff, protective position.

• Neurological signs and symptoms will be present if the nerves are affected.

What Is the Differential Diagnosis of Pott’s Spine?

Some differential diagnoses are:

• Pyogenic osteitis of the spine.

• Spinal tumors.

How Is Pott’s Spine Diagnosed?

During the diagnosis of this condition, some investigations may be performed, which may show:

• Elevation in the ESR level may indicate the presence of infection and inflammation.

• A Mantoux skin test may be performed, showing a bump's presence. This test will be positive in the case of Pott’s spine.

• Spinal X-ray will be shown normally in the initial stages of the condition as at least 50% of the bone needs to be destructed for the changes to be visible in the X-ray.

• MRI (Magnetic Resonance Imaging) can be done, showing the spine change even though the condition is in its starting stage.

• A CT (Computed Tomography) can also be recommended, but an MRI will help to assess the risk associated with the spinal cord.

• A needle biopsy of the bone or the synovial tissue will be performed. If the biopsy shows the presence of tubercle bacilli, then culture will be required. This culture should have mycology.

• Those people with extrapulmonary tuberculosis will be recommended with an X-ray and culture of the respiratory samples to rule out other existing pulmonary tuberculosis.

Is Pott’s Disease Curable?

Spine tuberculosis is curable through medication and surgery is not required. Most people affected by spinal tuberculosis are not aware that they an infection as it is difficult to feel or know the presence of the infection. If diagnosis is done properly then the condition can be cured using antibiotics.

How Is Pott’s Spine Managed?

• Usually, this condition can be treated through chemotherapy, but surgery may be required in some conditions.

• The spine will be immobilized for two to three months. Surgery will be recommended when there is no progress in the condition or when the neurological health does not show any improvement through anti-tubercular treatment, which includes chemotherapy.

• A multidisciplinary approach is required for better diagnosis and treatment.

Surgical Method

For people who have neurological problems, kyphotic deformities, or spinal instability, surgery will be recommended along with chemotherapy.

• In surgical intervention, the initial stage is eliminating tubercular infection. Before and after the surgery, anti-tubercular medication will be provided. Surgical reconstruction will be followed.

• The treatment will be planned based on the neurological involvement. If there is neurological involvement, then pharmacotherapy is recommended over surgical treatment.

• Surgery performed during the active course of the disease will produce better results.

What Are the Complications Related to Pott’s Spine?

• If the bone destruction continues, then it can result in vertebral collapse and kyphosis.

• A cold abscess will occur if the infection spreads to the adjacent soft tissue and ligaments.

What Is the Prognosis of Pott’s Spine?

• Usually, the prognosis is very slow but lasts for months or even years.

• A better prognosis will be seen if diagnosed earlier.

• Modern chemotherapy can produce good results.

• Poor prognosis is associated with Pott’s spine associated with neurological deformities or spinal instability. In these conditions, the diagnosis may be difficult.

Can Pott’s Spine Be Prevented?

• Pott’s spine can be prevented if the person takes the BCG vaccine.

• This condition can be prevented if the socio-economic condition is improved.

• Prevention of HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immunodeficiency Syndrome).

Conclusion

Pott’s spine is a condition where the spine gets infected by tuberculosis. This is also called spine tuberculosis, which can also be associated with spine instability, neurological deformities, etc. The spine is a very common region for skeletal tuberculosis. This condition can be diagnosed and treated through chemotherapy or surgery. If diagnosed earlier, then the prognosis will be good.