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Pott Disease

Pott Disease

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Published by: junkirin on Aug 24, 2009
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Pott disease
From Wikipedia, the free encyclopedia
(Redirected fromPott's disease)Jump to:navigation, search Tuberculosis of the spine in anEgyptianmummy
Pott disease
is a presentation of extrapulmonarytuberculosisthat affects the spine, a kindof tuberculous arthritis of the intervertebral joints. It is named after Percivall Pott(1714-1788), a London surgeon. Scientifically, it is called tuberculousspondylitisand it is mostcommonly localized in the thoracic portion of the spine.
Signs and symptoms
nightsweating
Spinal mass, sometimes associated withnumbness,tingling, or muscle weakness  of the legs
Diagnosis
radiographsof the spine
CTof the spine
 
Late complications
Vertebral collapse resulting inkyphosis
sinusformation
 paraplegia(so called Pott's paraplegia)
Prevention
Controlling the spread of tuberculosis infection can prevent tuberculous spondylitis andarthritis. Patients who have a positivePPD test(but not active tuberculosis) may decreasetheir risk by properly taking medicines to prevent tuberculosis. To effectively treattuberculosis, it is crucial that patients take their medications exactly as prescribed.
Therapy
non-operative -antituberculous drugs
immobilization of the spine region by rod (Hull)
Surgerymay be necessary, especially to drain spinalabscessesor to stabilize the spine
Richards intramedullary hip screw - facilitating for bone healing
Kuntcher Nail - intramedullary rod
Austin Moore - intrameduallary rod (for Hemiarthroplasty)
Pott's Disease (Spine)
Synonyms: Pott's syndrome, Pott's caries, Pott's curvature, angular kyphosis, kyphosis secondary to tuberculosis, tuberculosis of the spine, tuberculous spondylitis and David'sdisease
Description
Pott's disease is tuberculous caries or osteitis of the spinal column and must not beconfused with Pott's fracture of the ankle.The source of infection is usually outside the spine. It is most often spread from the lungsvia the blood. There is a combination of osteomyelitisand infective arthritis. Usuallymore than one vertebra is involved. The area most affected is the anterior part of thevertebral body adjacent to the subchondral plate.Tuberculosismay spread from that areato adjacent intervertebral discs. In adults, disc disease is secondary to the spread of 
 
infection from the vertebral body but in children it can be a primary site, as the disc isvascular in children.It is the commonest place for tuberculosis to affect the skeletal system although it canaffect the hips and knees too. The usual sites to be involved are the lower thoracic andupper lumbar vertebrae.The infection spreads from two adjacent vertebrae into the adjoining disc space. If onlyone vertebra is affected, the disc is normal, but if two are involved the disc between themcollapses as it is avascular and cannot receive nutrients. Caseation occurs, with vertebralnarrowing and eventuallyvertebral collapseand spinal damage. A dry soft tissue massoften forms and superinfection is rare.
Epidemiology
Pott's disease is rare in the UK but in developing countries it represents about 2%of cases of tuberculosis and 40 to 50% of musculoskeletal tuberculosis.
Tuberculosis worldwide accounts for 1.7 billion infections, and 2 million deaths per year.
Over 90% of TB occurs in poorer countries, but a global resurgence is affectingricher ones.
India, China, Indonesia, Pakistan and Bangladesh have the largest number of cases but there has been a marked increase in the number of cases in the former Soviet Union and in sub-Saharan Africa in parallel with the spread of HIV.
The disease affects males more than females in a ratio of between 1.5 and 2:1. Inthe USA it affects mostly adults but in the countries where it is commonest itaffects mostly children.
Risk factors
Poor socio-economic conditions
Presentation
Symptoms
The onset is gradual.
Back painis localised
Fever 
 Night sweats
Anorexia
Weight loss

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