Pott’s Disease / Tuberculosis of Spine

Pott’s disease is a presentation of extrapulmonary tuberculosis that affects the spine, a kind of
tuberculous arthritis of the intervertebral joints. Scientifically, it is called tuberculous spondylitis.
Pott’s disease is the most common site of bone infection in TB; hips and knees are also often
affected. The lower thoracic and upper lumbar vertebrae are the areas of the spine most often
affected.

Pott's disease, which is also known as Pott’s caries, David's disease, and Pott's curvature, is a
medical condition of the spine. Individuals suffering from Pott's disease typically experience
back pain, night sweats, fever, weight loss, and anorexia. They may also develop a spinal mass,
which results in tingling, numbness, or a general feeling of weakness in the leg muscles. Often,
the pain associated with Pott's disease causes the sufferer to walk in an upright and stiff position.

Pott’s disease is caused when the vertebrae become soft and collapse as the result of caries or
osteitis. Typically, this is caused by mycobacterium tuberculosis. As a result, a person with Pott's
disease often develops kyphosis, which results in a hunchback. This is often referred to as Pott’s
curvature. In some cases, a person with Pott's disease may also develop paralysis, referred to as
Pott’s paraplegia, when the spinal nerves become affected by the curvature.

ETIOLOGY of Pott's Disease

• Causative organism: Mycobacterium tuberculosis.

• Spread: Haematogenous. (by blood)
• Commonly associated with: Debilitating diseases, AIDS, Drug addiction, Alcoholism.

CLINICAL FEATURES of Tuberculosis of Spine

Symptoms

The onset is gradual.

• Back pain is localised.
• Restricted spinal movements.
• Fever.
• Night sweats.
• Anorexia.
• Weight loss.

Signs
• There may be kyphosis. (spinal curvature)
• Muscle wasting.
• A paravertebral swelling may be seen.
• They tend to assume a protective upright, stiff position.
• If there is neural involvement there will be neurological signs.
• A psoas abscess (may present as a lump in the groin and resemble a hernia).

Differential diagnosis

• Pyogenic osteitis of the spine.

• Spinal tumours.

INVESTIGATION for Pott's Disease

Blood

• TLC: Leucocytosis.
• ESR: raised during acute stage.

Tuberculin skin test

• Strongly positive.
• Negative test does not exclude diagnosis.

Aspirate from joint space & abscess

• Transparency: turbid.
• Colour: creamy.
• Consistency: cheesy.
• Fibrin clot: large.
• Mucin clot: poor.
• WBC: 25000/cc.mm.

Histology

• Shows granulomatous tubercle.

X-Ray spine

Early:-

• Narrowed joint space.

• Diffuse vertebral osteoporosis adjacent to joint.
• Erosion of bone.
• Fusiform paraspinal shadow of abscess in soft tissue.
Late:-

• Destruction of bone.
• Wedge-shaped deformity (collapse of vertebrae anteriorly).
• Bony ankylosis.

Complications

• Vertebral collapse resulting in kyphosis.

• Spinal cord compression.
• Sinus formation.
• Paraplegia (so called Pott's paraplegia).

GENERAL MANAGEMENT for Pott's Disease

• Bed rest.
• Immobilisation of affected joint by splintage.
• Nutritious, high protein diet.
• Drainage of abscess.
• Surgical decompression.
• Physiotherapy.

Homeopathic Treatment for Pott's Disease /

Spinal Tuberculosis
Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the
patient as a person, as well as his pathological condition. The homeopathic medicines are
selected after a full individualizing examination and case-analysis, which includes the medical
history of the patient, physical and mental constitution etc. A miasmatic tendency
(predisposition/susceptibility) is also often taken into account for the treatment of chronic
conditions. The medicines given below indicate the therapeutic affinity but this is not a complete
and definite guide to the treatment of this condition. The symptoms listed against each medicine
may not be directly related to this disease because in homeopathy general symptoms and
constitutional indications are also taken into account for selecting a remedy. To study any of the
following remedies in more detail, please visit our Materia Medica section. None of these
medicines should be taken without professional advice.

Homeopathic Remedies

Calc carb.

Pain as if sprained; can scarcely rise; from overlifting. Pain between shoulder-blades, impeding
breathing. Rheumatism in lumbar region; weakness in small of back. Curvature of dorsal
vertebrae. Nape of neck stiff and rigid.
Calc carb suits to person with Leucophlegmatic constitution, blond hair, light complexion, blue
eyes, fair skin; tendency to obesity in youth. Psoric constitutions; pale, weak, timid, easily tired
when walking. Disposed to grow fat, corpulent, unwieldy. Children with red face, flabby
muscles, who sweat easily and take cold readily in consequence. Large heads and abdomens;
fontanelles and sutures open; bones soft, develop very slowly. Curvature of bones, especially
spine and long bones; extremities crooked, deformed; bones irregularly developed. Head sweats
profusely while sleeping,

Calc phos.

Rheumatic pain and stiffness of neck with dulness of head, from slight drought of air. Cramp-
like pain in neck first one side then the other (right to left). Throbbing or jerking pains below
scapula. Violent pain in region of back when making the least effort. Backache and uterine pains.
Sharp pains in sacrum and coccyx. Soreness as if separate in sacro-illiac synchondrosis.
Curvature of the spine to the left, lumbar vertebrae bend to the left, spina bifida. Soreness in
sacro-iliac symphysis, as if broken.

Calc phos suits to person with anaemic and dark complexion, dark hair and eyes; thin spare
subjects, instead of fat.

Phos acid.

Tension and cramp-like drawing in muscles of neck, especially on moving head. Miliaria on
neck. Boring pain between scapulae. Spondylitis of cervical vertebrae.
Eruption, painful to touch, on back, shoulder-blades, neck, and chest. Burning pain in a spot
above small of back. Itching stitch in coccyx, fine stitches in coccyx and sternum. Crawling
(formication) tingling in back and loins.

Phos acid best suited to persons of originally strong constitutions, who have become debilitated
by loss of vital fluids.

Phosphorus.

Rigidity of nape of neck. Pressure on shoulders. Swelling of neck. Engorgement of axillary

glands and of those of nape of neck and of neck. Paralysed sensation in upper sacrum and lower
lumbar vertebrae. Contusive pain in loins and back (as if back were broken), especially after
having been seated a long time, hindering walking, rising up, or making the least movement.
Pain in small of the back when rising from a stooping position. Sensitiveness of spinous
processes of dorsal vertebrae to pressure. Softening of spine. Heat or burning in back, between
scapula. Tearings and stitches in and beneath both scapula. Pain in coccyx impeding easy
motion, can find no comfortable position, followed by painful stiffness of nape. Coccyx painful
to touch as from an ulcer. Transient pain from coccyx though spine to vertex that drew head back
during the stool. Backache and palpitations prevail.

Phos best adapted to tall slender persons of sanguine temperament, fair skin, eyelashes, fine
blond, or red hair, quick perceptions, and very sensitive nature. Young people who grow too
rapidly are inclined to stoop who are chlorotic or anaemic; old people, with morning diarrhoea.
Nervous, weak; desires to be magnetized Oversensitiveness of all the senses to external
impressions, light, noise, odors, touch. Restless, fidgety; moves continually, cannot sit or stand
still a moment Burning: in spots along the spine; between the scapulae; or intense heat running
up the back;of palms of hands in chest and lungs; of every
organ or tissue of the body generally in diseases of nervous system. Haemorrhage diathesis;
small wounds bleed profusely.

Silicea.

Stiffness of nape, with headache. Swelling of glands of nape, in the neck, and under the axillae
(with suppuration), sometimes with induration. Suppuration of axillary glands. Caries of
clavicle.Stitches between the hips.Coccyx painful, as after a long carriage ride.- Stinging in os
coccyges on rising, painful to pressure. -Scabby elevation on coccyx, above fissure of nates.-
Pain in the loins, which prevents rising up, and forces patient to remain lying down.-
Inflammatory abscess in lumbar region (on the psoas muscle).- Weakness and paralytic stiffness
in back, loins, and nape.- Tearings and shootings in the back.- Shootings in the loins, when
seated or lying down.-Burning in back when walking in open air and becoming warm.- Aching,
shooting, burning, and throbbing in lumbo-sacral region.- Swelling and distortion of spine
(curvature of the vertebrae).-Contusive pain between the shoulder-blades.

Silicea best adapted to the nervous, irritable, sanguine temperament; persons of a psoric
diathesis. Persons of light complexion; fine dry skin; pale face; weakly, with lax muscles.
Constitutions which suffer from deficient nutrition, not because food is lacking in quality or
quantity, but from imperfect assimilation. Oversensitive, physically and mentally. Scrofulous,
rachitic children with large heads; open fontanelles and sutures; much sweating about the head.

Sulphur.

Stiffness of neck, in nape, with paralytic, sprained pain. Child cannot hold head up neck muscles
so weak. Tetters on nape. Swelling and inflammation of glands of nape and of neck.Swelling and
suppuration of axillary glands. Cracking in vertebrae of neck, especially on bending backwards.
Weakness and wrenching pains, or pain as from a bruise in loins, coccyx, and in back, especially
on walking, or rising from a seat. Gnawing pain in small of back. Pain in small of back not
permitting one to stand erect. Finds himself at night lying on back. Cannot lie on back on
account of rush of blood to head. Pain in back after manual labour. Shootings in loins, back, and
shoulder-blades, sometimes with obstructed respiration. Sharp and rheumatic pains, drawing,
tension, and stiffness in loins, back,and nape. Pinching and burning sensation between the
shoulder-blades. Tension and bruised pain between scapulae and in nape, which on moving head
goes to shoulders. Stitches beneath scapulae which take away the breath. Drawing in right
scapula, evening on going to sleep. Tearing in left scapula while sitting. Needle-shoots at point
of left scapula. Sprained pains in back. During whole day aching in small of back, worse when
urinating.Distortion (curvature) of spine. Vertebrae softened. Cracking of vertebrae on bending
head backward.
Sulphur Adapted to persons of a scrofulous diathesis, subject to venous congestion; especially of
portal system. Persons of nervous temperament, quick motioned, quick tempered, plethoric, skin
excessively sensitive to atmospheric changes. For lean, stoop-shouldered persons who walk and
sit stooping like old men. Standing is the worst position for sulphur patients; they cannot stand;
every standing position is uncomfortable. Dirty, filthy people, prone to skin affections. Aversion
to being washed; always <. after a bath.

Symphytum.

Pain in back from a fall, from sexual excess. Pott's disease after injury. Psoas abscess. Much
used among herbalists in caries of spinal and other bones.
Symphytum facilitates union of fractured bones; lessens peculiar pricking pain; favors
production of callous; when trouble is of nervous origin. Irritability at point of fracture;
periosteal pains after wounds have healed.
Pott disease
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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, 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.

Contents
[hide]

 1 Signs and symptoms

 2 Diagnosis
 3 Late complications
 4 Prevention
 5 Therapy
 6 Cultural references
 7 External links

[edit] Signs and symptoms

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

[edit] Diagnosis

 blood tests - elevated erythrocyte sedimentation rate

 tuberculin skin test
 radiographs of the spine
 bone scan
 CT of the spine
 bone biopsy
 MRI

[edit] Late complications

 Vertebral collapse resulting in kyphosis

 Spinal cord compression
 sinus formation
  paraplegia (so called Pott's paraplegia)

[edit] 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.

[edit] Therapy

 non-operative - antituberculous drugs

 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)

[edit] Cultural references

The fictional Hunchback of Notre Dame had a gibbous deformity (humpback) that is thought to
have been 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.
The 18th-century English poet Alexander Pope 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. Morton, the railroad magnate in Once Upon a Time in the West, suffers
from the disease and needs crutches to walk.