Pott disease

Pott 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. Scientifically, it is called tuberculous spondylitis and it is most commonly localized in the thoracic portion of the spine.

Signs and symptoms

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

Diagnosis

• blood tests - elevated erythrocyte sedimentation rate
• tuberculin skin test
• radiographs of the spine
• bone scan
• CT of the spine
• bone biopsy
• MRI

Late complications

• Vertebral collapse resulting in kyphosis
• Spinal cord compression
• sinus formation
• paraplegia (so called Pott's paraplegia)

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.

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)

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. Chick Webb, swing era drummer and band leader, was afflicted with tuberculosis of the spine as a child, which left him hunchbacked.

External links

• Pott Disease Tuberculous Spondylitis - from eMedicine - medical article with MRI picture
• Tuberculous arthritis MedlinePlus. Public domain text from the US Government.