Pott's disease

Pott's Disease
Classification and external resources
ICD-10	A18.0, M49.0
ICD-9	015.0
MeSH	D014399

Tuberculosis of the spine in an Egyptian mummy

Pott's disease or Pott disease is a presentation of extrapulmonary tuberculosis that affects the spine, a kind of tuberculous arthritis of the intervertebral joints. It is named after Percivall Pott (1714–1788), a London surgeon who trained at St Bartholomew's Hospital, London. The lower thoracic and upper lumbar vertebrae are the areas of the spine most often affected. Scientifically, it is called tuberculous spondylitis and it is most commonly localized in the thoracic portion of the spine. Pott’s disease results from haematogenous spread of tuberculosis from other sites, often pulmonary. The infection then spreads from two adjacent vertebrae into the adjoining intervertebral disc space. If only one vertebra is affected, the disc is normal, but if two are involved, the 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.

Signs and symptoms

• back pain
• fever
• night sweating
• anorexia
• Spinal mass, sometimes associated with numbness, paraesthesia, or muscle weakness of the legs

Diagnosis

• blood tests

- CBC : leukocytisis – elevated erythrocyte sedimentation rate >100 mm/h

• tuberculin skin test

- Tuberculin skin test (purified protein derivative [PPD]) results are positive in 84-95% of patients with Pott disease who are not infected with HIV.

• radiographs of the spine

- Radiographic changes associated with Pott disease present relatively late. The following are radiographic changes characteristic of spinal tuberculosis on plain radiography:

         Lytic destruction of anterior portion of vertebral body
         Increased anterior wedging
         Collapse of vertebral body
         Reactive sclerosis on a progressive lytic process
         Enlarged psoas shadow with or without calcification

- Additional radiographic findings may include the following:

         Vertebral end plates are osteoporotic.
         Intervertebral disks may be shrunk or destroyed.
         Vertebral bodies show variable degrees of destruction.
         Fusiform paravertebral shadows suggest abscess formation.
         Bone lesions may occur at more than one level.

• bone scan
• CT of the spine
• bone biopsy
• MRI

Late complications

• Vertebral collapse resulting in kyphosis
• Spinal cord compression
• sinus formation
• paraplegia (so called Pott's paraplegia)

Prevention

Controlling the spread of tuberculosis infection can prevent tuberculous spondylitis and arthritis. Patients who have a positive PPD test (but not active tuberculosis) may decrease their risk by properly taking medicines to prevent tuberculosis. To effectively treat tuberculosis, it is crucial that patients take their medications exactly as prescribed.

Therapy

• non-operative – antituberculous drugs
• Chiropractic treatments
• analgesics
• immobilization of the spine region by rod (Hull)
• Surgery may be necessary, especially to drain spinal abscesses or to stabilize the spine
• Richards intramedullary hip screw – facilitating for bone healing
• Kuntcher Nail – intramedullary rod
• Austin Moore – intrameduallary rod (for Hemiarthroplasty)
• Thoracic spinal fusion as a last resort

Cultural references

The fictional Hunchback of Notre Dame had a gibbous deformity (humpback) similar to the type caused by tuberculosis. In Henrik Ibsen's play "A Doll's House," Dr. Rank suffers from "consumption of the spine." Furthermore, Jocelin, the Dean who wanted a spire on his cathedral in William Golding's "The Spire" probably suffered and died as a result of this disease. English poets Alexander Pope and William Ernest Henley both suffered from Pott's disease. Anna Roosevelt Cowles, sister of president Theodore Roosevelt, suffered from Pott's Disease. Chick Webb, swing era drummer and band leader, was afflicted with tuberculosis of the spine as a child, which left him hunchbacked. The Sicilian mafia boss Luciano Leggio had Pott's disease and wore a brace. Morton, the railroad magnate in Once Upon a Time in the West, suffers from the disease and needs crutches to walk. Writer Max Blecher also had Pott's Disease. Marxist thinker and Communist leader Antonio Gramsci suffered from Pott's disease, probably due to the bad conditions of his incarceration in fascist Italy during the 1930s. Italian writer, poet and philosopher Giacomo Leopardi suffered from this disease. It also features prominently in the book This Is a Soul, which chronicles the work of American physician Rick Hodes in Ethiopia.

External links

• "Tuberculous arthritis", MedlinePlus, USA: NIH. Public domain.

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