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POTTS 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. Potts 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. -which is also known as Potts caries, David's disease, and Pott's curvature. Causative organism: Mycobacterium tuberculosis. Spread: Haematogenous. (by blood) Commonly associated with: Debilitating diseases, AIDS, Drug addiction, Alcoholism.

SIGNS
gibbus formation - pathognomonic sign There may be kyphosis. (spinal curvature) Muscle wasting. protective upright, stiff position. A psoas abscess (may present as a lump in the groin and resemble a hernia).

SYMPTOMS The onset is gradual.


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

DIAGNOSTIC PROCEDURE
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).

TREATMENT AND MEDICAL MANAGEMENT


Drug treatment (R.I.P.E.S. and other antibiotic) is generally sufficient for Potts disease, with spinal immobilization if required. Surgery is required if there is spinal deformity or neurological signs of spinal cord compression.

Standard antituberculosis treatment is required. Duration of antituberculosis treatment:

If debridement and fusion with bone grafting are performed, treatment can be for six months. If debridement and fusion with bone grafting are NOT performed a

minimum of 12 months treatment is required. It may also be necessary to immobilize the area of the spine affected by the disease, or the person may need to undergo surgery in order to drain any abscesses that may have formed or to stabilize the spine.

Other interventions include application of knight/ taylor brace, head halter traction.

Surgery plays an important part in the management. It confirms the diagnosis, relieves compression if it occurs, permits evacuation of pus, and reduces the degree of deformation and the duration of treatment.

Surgery includes ADSF ( Anterior decompression Spinal fusion).

NURSING CARE MANAGEMENT


Provide bed rest to avoid unnecessary body energy expenditure. Assess for pain and provide analgesics as prescribed. Proper care of traction. Reposition the client every 2hrs. Proper care of thoracostomy tube (milking technique) for continuous flow of secretion. Encourage deep breathing exercise to promote lung expansion. Do passive range of motion exercise (ROM). Instruct diet high in protein and fiber. Increase fluid intake. Provide comfort. P atient should be reminded to attend check-ups at the nearest O rthopedic center. T reatment shoud be taken in a T imely manner. S ight any symptoms other than usual and report it to the physician

POTTS DISEASE

KNIGHT/TAYLOR BRACE

REFERENCES: http://www.hpathy.com www.google.com www.wikipedia.com