Pott disease

Pott disease is tuberculosis of the spine,[1] usually due to haematogenous spread from other sites, often the lungs. The lower thoracic and upper lumbar vertebrae areas of the spine are most often affected.

Pott disease
Tuberculosis spine mummy.jpg
Tuberculosis of the spine in an Egyptian mummy
SpecialtyRheumatology Edit this on Wikidata
SymptomsPott's spine, tuberculous spondylitis, spinal tuberculosis
Diagnostic methodRadiograph, Bone scan, MRI

It causes a kind of tuberculous arthritis of the intervertebral joints. The infection can spread 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. In a process called caseous necrosis, the disc tissue dies, leading to vertebral narrowing and eventually to vertebral collapse and spinal damage. A dry soft-tissue mass often forms and superinfection is rare.

Spread of infection from the lumbar vertebrae to the psoas muscle, causing abscesses, is not uncommon.[2]

The disease is named after Percivall Pott, the British surgeon who first described it in the late 18th century.

DiagnosisEdit

Complete blood count: leukocytosis
– Elevated erythrocyte sedimentation rate: >100 mm/h
– Tuberculin skin test (purified protein derivative [PPD]) results are positive in 84–95% of patients with Pott disease who are not infected with HIV.
 
A girl from Oklahoma, who has been affected by bone tuberculosis, 1935
– Radiographic changes associated with Pott disease present relatively late. These radiographic changes are characteristic of spinal tuberculosis on plain radiography:
  1. Lytic destruction of anterior portion of vertebral body
  2. Increased anterior wedging
  3. Collapse of vertebral body
  4. Reactive sclerosis on a progressive lytic process
  5. Enlarged psoas shadow with or without calcification
– Additional radiographic findings may include:
  1. Vertebral end plates are osteoporotic
  2. Intervertebral disks may be shrunken or destroyed
  3. Vertebral bodies show variable degrees of destruction
  4. Fusiform paravertebral shadows suggest abscess formation
  5. Bone lesions may occur at more than one level

PreventionEdit

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, patients must take their medications exactly as prescribed.[citation needed]

ManagementEdit

  • Nonoperative – antituberculous drugs
  • Analgesics
  • Immobilization of the spine region using different types of braces and collars
  • Surgery may be necessary, especially to drain spinal abscesses or debride bony lesions fully or to stabilize the spine. A 2007 review found just two randomized clinical trials with at least one-year follow-up that compared chemotherapy plus surgery with chemotherapy alone for treating people diagnosed with active tuberculosis of the spine. As such, no high-quality evidence exists, but the results of this study indicates that surgery should not be recommended routinely and clinicians have to selectively judge and decide on which patients to operate.[3]
  • Thoracic spinal fusion with or without instrumentation as a last resort.
  • Physical therapy for pain-relieving modalities, postural education, and teaching a home-exercise program for strength and flexibility

PrognosisEdit

HistoryEdit

In works of fictionEdit

  • In Ernest Poole's Pulitzer Prize-winning novel, His Family, young Johnny Geer has a terminal case of Pott disease.
  • The fictional Hunchback of Notre Dame has a gibbus deformity similar to the type caused by tuberculosis.
  • In Henrik Ibsen's play A Doll's House, Dr. Rank has "consumption of the spine".
  • Jocelin, the dean who wanted a spire on his cathedral in William Golding's The Spire, probably died as a result of the disease.
  • Morton, the railroad magnate in the film Once Upon a Time in the West, has the disease and needs crutches to walk.
  • Imogen, in the novella "The Princess with the Golden Hair", part of Memoirs of Hecate County by Edmund Wilson (1946), has Pott disease.
  • In the story Two Gentlemen of Verona, written by A. J. Cronin, Lucia had tuberculosis of spine.
  • The semi-autobiographical novel Inimi cicatrizate by Max Blecher and the Radu Jude film Scarred Hearts loosely based on it are about a young man, Emanuel, afflicted with Pott disease in a sanatorium.

ReferencesEdit

  1. ^ Garg, RK; Somvanshi, DS (2011). "Spinal tuberculosis: a review". The Journal of Spinal Cord Medicine. 34 (5): 440–54. doi:10.1179/2045772311Y.0000000023. PMC 3184481. PMID 22118251.
  2. ^ Wong-Taylor, LA; Scott, AJ; Burgess, H (20 May 2013). "Massive TB psoas abscess". BMJ Case Reports. 2013: bcr2013009966. doi:10.1136/bcr-2013-009966. PMC 3670072. PMID 23696148.
  3. ^ Jutte PC, van Loenhout-Rooyackers JH. Routine surgery in addition to chemotherapy for treating spinal tuberculosis. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD004532. DOI: 10.1002/14651858.CD004532.pub2. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004532.pub2/abstract
  4. ^ Krasnik, Benjamin (2013). "Kierkegaard døde formentlig af Potts sygdom" (in Danish). Kristeligt Dagblad. Archived from the original on 2016-10-13. Retrieved 2016-10-02.
  5. ^ The Hiding Place, Chapter: "Since Then"
  6. ^ Covington, Richard. "Marie Antoinette". Smithsonian. Retrieved 2019-08-18.

External linksEdit