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Description

Pott's disease, is tuberculosis of the spine,[1][2] 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.[1][2]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. [3][1][2]As to the management of Pott's disease, the two routes that are prescribed to inividuals are chemotherapy and surgical intervention.[4]

Presentation

The onset of symptoms is gradual and disease progresses slowly.[5] The duration of symptoms before diagnosis ranges from 2 weeks to year(s). The average period was at least 12 months, but it has recently decreased to 3 and 6 months.[5] Further presentations include:[1] back pain, fever, night sweats, weight loss and fatigue.

Risk factors

Some known risk factors for Pott's Disease include immunodeficiencies (such as those caused by alcohol and drug abuse or HIV), exposure to infected individuals, and undernourishment. HIV has been identified as one of the primary risk factors for the development of Pott's Disease and this is because HIV compromises the immune system by attacking and destroying crucial immune cells, thereby weakening the body's natural defenses.[6]

Transmission

MTB is contracted and spread through aerosol droplets.[7] Respiratory MTB or tuberculosis have been documented in individuals that have negative results for specific cultures.[8] The sum of two cases concluded that about 17 percent of transmission occurs from patients who have negative results.[8]

Pathogenesis

Infection of the lungs by the bacteria Mycobacterium tuberculosis eventually spreads through the host's body.[7] Without treatment and diagnosis, the infection becomes dormant in the lungs or spreads to other parts of the body through hematogenous dissemination.[7]When dissemination occurs, MTB enters the cancellous or spongy bone of the vertebra through the vascular system.[7] It travels specifically from the front and back spinal arteries, and pressures within the torso spreads the infection throughout the vertebral body.[7][5]

Diagnosis

Initial suspicion of Pott's Disease is usually based on clinical symptoms and imaging findings, but a definitive diagnosis requires isolating the organism by culture, identifying it, and determining its drug susceptibility. The typical lab procedure for clinical specimens involves an AFB stain. The erythrocyte sedimentation rate and C-reactive protein are also used as biomarkers for spinal tuberculosis. Other labs include: [1][2][9] blood tests, Tuberculin skin test, radiographs of the spine, CT of the spine and MRI.

Differential diagnosis

As to the differential diagnosis we find that Pott's disease it is as follows:[1] atypical bacteria, fungi and spirochetes.

Treatment 1

The treatment prescribed to patients diagnosed with Pott's disease is similar to treatment that is generally given to patients who have other forms of extrapulmonary tuberculosis.[4] According to guidelines, typical treatment begins with a six to nine month course of drug treatment.[4][10] The regimen usually consists of an initial 2-month intensive phase of Isoniazid , Rifampin , Pyrazinamide , and Ethambutol .[4] Following the 2-month initial phase, PZA and EMB are discontinued while INH and RIF are continued for the remaining four to seven month continuation phase of the treatment period.[4]

Treatment 2

Surgical intervention is required for patients with Pott's disease in the event that there is a need for tissue sampling to clarify diagnoses, resistance to chemotherapy, neurologic deficits , paravertebral abscesses formed from bacterial induced immune response, and kyphotic deformities leading to instability of the spine.[9]There are several types of surgical intervention, the first is used in patients with kyphosis to primarily prevent the progression of kyphosis in active disease and correct it to a certain extent.[11]

Treatment 3

In the second which is posterior decompression and fusion with bone autografts, the goal is to relieve pressure on the spinal cord and nerves in the lower back and prevent the progression of kyphosis in active disease.[12][11] In this procedure, the lumbar (lower back) vertebrae (L1 to L5) are exposed and the intervertebral discs and vertebral material impinging on the spinal cord and/or nerves are removed.[12]

Treatment 4

As to the third which is anterior debridement/decompression and fusion with bone autografts procedure is to relieve pressure on the spinal cord and nerves along the anterior side of the spinal cord and help prevent the progression of kyphosis in active disease.[11][13]The anterior approach is often recommended instead of the posterior approach in cases where only single segments of the vertebrae are affected, and in the event that there is no destruction or collapse of the posterior elements.[13]

Treatment 5

In children with Pott's disease, earlier surgical intervention is often recommended to reduce their increased risk for kyphotic deformity.[9]This increased risk for deformity is attributed to both the anatomy and biomechanics of children and their developmental stage of life.[9][14]

Prognosis

The prognosis may include the following stages based on the prognostic evaluation: "Predestructive stage," with a duration of less than three months. "Early destructive stage," "Mild angular kyphosis," "Moderate angular kyphosis," and "Severe angular kyphosis," involving more than three vertebrae with kyphosis (greater than 60 degrees), with recovery exceeding two years.[1]

Epidemiology

About 2 percent of all cases of tuberculosis are considered Pott's Disease [15] and about half of the cases of musculoskeletal tuberculosis are Pott's Disease.[7][16] The disease can be attributed to 1 (point) 3 million deaths per year. [1]

History

Evidence of tubercular lesions of the vertebral column have been found from the fourth millennium BC in the form of Mesolithic remains in Liguria, Italy. Additionally, tuberculosis spondylitis has been discovered from 3400 BC in the mummified remains of Egyptians. Tuberculosis had affected humans long before it was identified by Sir Percivall Pott.[17]

Society and culture

Some historical figures that may have been affected by Pott's disease are: Søren Kierkegaard may have died from Pott disease, according to professor Kaare Weismann and literature scientist Jens Staubrand.[18] Willem Ten Boom, brother of Corrie Ten Boom, died of tuberculosis of the spine in December 1946.[19]And finally, Louis Joseph, Dauphin of France, son of King Louis XVI and Marie Antoinette.[20]

Research

A 2023 study on the evaluation of spinal TB showed that combining T-SPOT with Xpert achieved 95 (point) 1 percent sensitivity and 100 percent specificity. Deep learning models like Mask R-CNN now outperform radiologists in CT-based lesion detection, and metagenomic sequencing helps identify coinfections and non-tuberculous pathogens.[21]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Garg, Ravindra Kumar; Somvanshi, Dilip Singh (2011). "Spinal tuberculosis: a review". The Journal of Spinal Cord Medicine. 34 (5): 440–454. doi:10.1179/2045772311Y.0000000023. ISSN 1079-0268.
  2. ↑ 2.0 2.1 2.2 2.3 Pott Disease (Tuberculous Spondylitis) at eMedicine
  3. ↑ Wong-Taylor LA, Scott AJ, Burgess H (May 2013). "Massive TB psoas abscess". BMJ Case Reports. 2013: bcr2013009966. doi:10.1136/bcr-2013-009966. PMC 3670072. PMID 23696148.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Nahid, Payam; Dorman, Susan E.; Alipanah, Narges; Barry, Pennan M.; Brozek, Jan L.; Cattamanchi, Adithya; Chaisson, Lelia H.; Chaisson, Richard E.; Daley, Charles L.; Grzemska, Malgosia; Higashi, Julie M.; Ho, Christine S.; Hopewell, Philip C.; Keshavjee, Salmaan A.; Lienhardt, Christian; Menzies, Richard; Merrifield, Cynthia; Narita, Masahiro; O'Brien, Rick; Peloquin, Charles A.; Raftery, Ann; Saukkonen, Jussi; Schaaf, H. Simon; Sotgiu, Giovanni; Starke, Jeffrey R.; Migliori, Giovanni Battista; Vernon, Andrew (1 October 2016). "Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 63 (7): e147 – e195. doi:10.1093/cid/ciw376. ISSN 1537-6591. Retrieved 1 October 2025.
  5. ↑ 5.0 5.1 5.2 Ansari, Sajid; Amanullah, Md. Farid; Rauniyar, RajKumar; Ahmad, Kaleem (2013). "Pott′s spine: Diagnostic imaging modalities and technology advancements". North American Journal of Medical Sciences. 5 (7): 404–411. doi:10.4103/1947-2714.115775. PMC 3759066. PMID 24020048.
  6. ↑ CDC (2024-06-17). "TB Risk and People with HIV". Tuberculosis (TB). Retrieved 2024-08-01.
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 Glassman, Ira; Nguyen, Kevin H.; Giess, Jane; Alcantara, Cheldon; Booth, Michelle; Venketaraman, Vishwanath (25 January 2023). "Pathogenesis, Diagnostic Challenges, and Risk Factors of Pott's Disease". Clinics and Practice. 13 (1): 155–165. doi:10.3390/clinpract13010014. ISSN 2039-7275.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  8. ↑ 8.0 8.1 Schirmer, Patricia; Renault, Cybèle A.; Holodniy, Mark (August 2010). "Is spinal tuberculosis contagious?". International Journal of Infectious Diseases. 14 (8): e659–666. doi:10.1016/j.ijid.2009.11.009. PMID 20181507.
  9. ↑ 9.0 9.1 9.2 9.3 Rasouli MR, Mirkoohi M, Vaccaro AR, Yarandi KK, Rahimi-Movaghar V (December 2012). "Spinal tuberculosis: diagnosis and management". Asian Spine Journal. 6 (4): 294–308. doi:10.4184/asj.2012.6.4.294. PMC 3530707. PMID 23275816.
  10. ↑ Lee JY (April 2015). "Diagnosis and treatment of extrapulmonary tuberculosis". Tuberculosis and Respiratory Diseases. 78 (2): 47–55. doi:10.4046/trd.2015.78.2.47. PMC 4388900. PMID 25861336.
  11. ↑ 11.0 11.1 11.2 Jain, Anil K.; Dhammi, Ish Kumar; Jain, Saurabh; Mishra, Puneet (April 2010). "Kyphosis in spinal tuberculosis - Prevention and correction". Indian Journal of Orthopaedics. 44 (2): 127–136. doi:10.4103/0019-5413.61893. ISSN 1998-3727.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  12. ↑ 12.0 12.1 Jun DS, Yu CH, Ahn BG (September 2011). "Posterior direct decompression and fusion of the lower thoracic and lumbar fractures with neurological deficit". Asian Spine Journal. 5 (3): 146–154. doi:10.4184/asj.2011.5.3.146. PMC 3159062. PMID 21892386.
  13. ↑ 13.0 13.1 Anshori F, Priyamurti H, Rahyussalim AJ (2020). "Anterior debridement and fusion using expandable mesh cage only for the treatment of paraparese due to spondylitis tuberculosis: A case report". International Journal of Surgery Case Reports. 77: 191–197. doi:10.1016/j.ijscr.2020.10.126. PMC 7652712. PMID 33166818.
  14. ↑ Govender S, Ramnarain A, Danaviah S (July 2007). "Cervical spine tuberculosis in children". Clinical Orthopaedics and Related Research. 460: 78–85. doi:10.1097/BLO.0b013e31806a915f. PMID 17620809.
  15. ↑ Ansari, Sajid; Amanullah, Md. Farid; Rauniyar, RajKumar; Ahmad, Kaleem (2013). "Pott′s spine: Diagnostic imaging modalities and technology advancements". North American Journal of Medical Sciences. 5 (7): 404–411. doi:10.4103/1947-2714.115775. ISSN 1947-2714. PMC 3759066. PMID 24020048. Archived from the original on 2023-02-09. Retrieved 2025-04-28.
  16. ↑ Manno RL, Yazdany J, Tarrant TK, Kwan M (2022). Current Medical Diagnosis & Treatment 2023. McGraw Hill Education. ISBN 978-1-2646-8734-3.
  17. ↑ Khoo, Larry T; Mikawa, Kevin; Fessler, Richard G (March 2003). "A surgical revisitation of Pott distemper of the spine". The Spine Journal. 3 (2): 130–145. doi:10.1016/S1529-9430(02)00410-2. PMID 14589227.
  18. ↑ Krasnik B (2013). "Kierkegaard døde formentlig af Potts sygdom" [Kierkegaard probably died of Pott's disease] (in dansk). Kristeligt Dagblad. Archived from the original on 2016-10-13. Retrieved 2016-10-02.
  19. ↑ Ten Boom C, Sherrill C, Sherrill J (2015). "Since Then". The Hiding Place. Hendrickson Publishers. ISBN 978-1-61970-597-5.
  20. ↑ Covington R. "Marie Antoinette". Smithsonian. Archived from the original on 2024-01-24. Retrieved 2019-08-18.
  21. ↑ Li, Zhaoxin; Wang, Jin; Xiu, Xin; Shi, Zhenpeng; Zhang, Qiang; Chen, Deqiang (18 October 2023). "Evaluation of different diagnostic methods for spinal tuberculosis infection". BMC Infectious Diseases. 23 (1): 695. doi:10.1186/s12879-023-08655-5. ISSN 1471-2334. Archived from the original on 24 June 2024. Retrieved 9 October 2025.{{cite journal}}: CS1 maint: unflagged free DOI (link)
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