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Pott’s diseaseDefinition
Pott’s disease is a presentation of extrapulmonarytuberculosisthat affects thespine, a kind of tuberculous arthritis of the intervertebral joints. It is named after Percivall Pott(1714-1788), a London surgeon who trained at Barts. Scientifically, it iscalled tuberculousspondylitisand it is most commonly localized in the thoracic portionof the spine.
AKA:
Pott's syndrome, Pott's caries, Pott's curvature, angular kyphosis, kyphosissecondary to tuberculosis, tuberculosis of the spine, tuberculous spondylitis and David'sdisease
Incidence
United States
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Although the incidence of tuberculosis increased in the late 1980s to early 1990s,the total number of cases has decreased in recent years.
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The frequency of extrapulmonary tuberculosis has remained stable.
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Bone and soft-tissue tuberculosis accounts for approximately 10% of extrapulmonary tuberculosis cases and between 1% and 2% of total cases.
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Tuberculous spondylitis is the most common manifestation of musculoskeletaltuberculosis, accounting for approximately 40-50% of cases.
InternationalApproximately 1-2% of total tuberculosis cases are attributable to Pott disease.In the Netherlands between 1993 and 2001, tuberculosis of the bone and jointsaccounted for 3.5% of all tuberculosis cases (0.2-1.1% in patients of European originand 2.3-6.3% in patients of non-European origin).Mortality/Morbidity
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Pott disease is the most dangerous form of musculoskeletal tuberculosisbecause it can cause bone destruction, deformity, and paraplegia.
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Pott disease most commonly involves the thoracic and lumbosacral spine.However, published series have show some variation.
Lower thoracic vertebrae isthe most common area of involvement (40-50%), followed closely by the lumbar spine (35-45%). In other series, proportions are similar but favor lumbar spineinvolvement.
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Approximately 10% of Pott disease cases involve the cervical spine.
Risk/ Predisposing factors
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Manifestation:back pain
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nightsweating
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Data from Los Angeles and New York show that musculoskeletal tuberculosisprimarily affects African Americans, Hispanic Americans, Asian Americans, andforeign-born individuals.
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As with other forms of tuberculosis, the frequency of Pott Disease is related tosocioeconomic factors and historical exposure to the infection.Sex
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Although some series have found that Pott disease does not have a sexualpredilection, the disease is more common in males (male-to-female ratio of 1.5-2:1).Age
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In the United States and other developed countries, Pott disease occurs primarilyin adults.
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In countries with higher rates of Pott disease, involvement in young adults andolder children predominates.
Type/ Stage/ Classification
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Bone/Spinal Disease
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Non-Communicable Disease
Pathophysiology
Pott’s disease is usually secondary to an extraspinal source of infection. Thebasic lesion involved in Pott’s disease is a combination of osteomyelitis andarthritisthatusually involves more than one vertebra. The anterior aspect of the vertebral bodyadjacent to the subchondral plate is area usually affected.Tuberculosismay spreadfrom that area to adjacent intervertebral disks. In adults, disk disease is secondary tothe spread of infection from the vertebral body. In children, because the disk isvascularized, it can be a primary site.Progressive bone destruction leads to vertebral collapse andkyphosis.The
spinal canal can be narrowed by abscesses, granulation tissue, or direct dural invasion,leading to spinal cord compression and neurologic deficits. The kyphotic deformity iscaused by collapse in the anterior spine. Lesions in the thoracic spine are more likely tolead to kyphosis than those in the lumbar spine. A cold abscess can occur if theinfection extends to adjacent ligaments and soft tissues. Abscesses in the lumbar regionmay descend down the sheath of the psoas to the femoral trigone region and eventuallyerode into the skin.
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