Spinal TB, also known as Pott's disease or tuberculous spondylitis, is a form of tuberculosis that affects the spine, causing bone destruction and potential complications. It's caused by the Mycobacterium tuberculosis bacteria, the same bacteria that causes lung TB.

 

🦴 POTT’S DISEASE (Spinal Tuberculosis)

📌 What is Pott’s Disease?

Pott’s disease is a form of tuberculosis (TB) that affects the spine, specifically the vertebrae. It’s caused by the Mycobacterium tuberculosis bacteria — the same bacteria responsible for pulmonary TB.

• Named after Percivall Pott, an English surgeon who first described the condition in the 18th century.

• Also called tuberculous spondylitis.

It is one of the most dangerous forms of TB because it can lead to spinal deformity, paralysis, and neurological complications if untreated.

🧫 Cause

• Infection by Mycobacterium tuberculosis.

• The bacteria typically spread from the lungs or lymph nodes through the bloodstream or lymphatic system to the spinal bones.

• The thoracic and lumbar spine are most commonly affected.

⚠️ Risk Factors

• Existing or previous TB infection

• Immunocompromised states (e.g., HIV/AIDS, cancer)

• Malnutrition

• Poor living conditions or overcrowded environments

• Organ transplantation

• Diabetes

🧠 How Does it Affect the Spine?

1. TB spreads to the vertebral body, causing inflammation and bone destruction.

2. The intervertebral discs can collapse.

3. Abscesses may form, often called cold abscesses, because they lack redness/heat.

4. If the spinal cord is compressed, it may result in neurological deficits or paralysis.

🩺 Signs & Symptoms

Symptoms develop slowly over weeks or months.

General TB symptoms:

• Low-grade fever (especially in the evening)

• Night sweats

• Weight loss

• Fatigue

• Loss of appetite

Spinal-specific symptoms:

• Persistent back pain (main symptom)

• Pain worsens at night or with movement

• Stiffness and limited mobility of the spine

• Swelling or a visible hump (gibbus deformity)

• Cold abscess in the psoas or paraspinal area

• Neurological deficits:

  • Weakness or numbness in legs

  • Tingling or burning

  • Bowel or bladder incontinence (late stage)

🧪 Diagnosis

1. Clinical Examination

• Based on back pain history, systemic TB signs, and neurological symptoms.

2. Imaging Tests

• X-ray: Shows late changes — bone destruction, vertebral collapse, kyphosis.

• MRI: Gold standard — shows early signs, spinal cord compression, and soft tissue involvement.

• CT Scan: Helpful for surgical planning and detecting bony destruction.

3. Lab Tests

• ESR & CRP: Usually elevated (markers of inflammation).

• Tuberculin skin test (Mantoux) or IGRA: Suggest prior TB exposure.

• Sputum test (if pulmonary TB is also suspected).

• Biopsy or aspiration of abscess: Confirm diagnosis via histopathology or culture of M. tuberculosis.

🧬 Differential Diagnosis

Pott’s disease may mimic:

• Spinal tumors

• Pyogenic (bacterial) spondylitis

• Disc herniation

• Metastasis

• Brucellosis

💊 Treatment of Pott’s Disease

1. Anti-Tuberculosis Therapy (ATT)

The cornerstone of treatment.

Typical regimen:

• Intensive phase (2 months):

  • Isoniazid (H)

  • Rifampicin (R)

  • Pyrazinamide (Z)

  • Ethambutol (E)

• Continuation phase (7–10 months):

  • Isoniazid + Rifampicin (± Ethambutol)

⏳ Total treatment duration: Usually 9 to 12 months. In some severe cases, up to 18 months.

2. Surgical Intervention (if needed)

Indications:

• Spinal cord compression

• Progressive neurological symptoms

• Severe spinal instability or deformity

• Large abscesses not responding to medication

Procedures may include:

• Laminectomy

• Decompression

• Spinal fusion

• Abscess drainage

3. Supportive Treatment

• Bracing for spinal support

• Physiotherapy to prevent stiffness and muscle wasting

• Nutritional support

🧠 Complications (if untreated or late-diagnosed)

• Kyphosis (spinal curvature)

• Paraplegia or quadriplegia

• Permanent nerve damage

• Cold abscess rupture

• Chronic pain and disability

🧾 Prognosis

• With early diagnosis and proper treatment, most patients recover well without permanent damage.

• Prognosis worsens if treatment is delayed or if significant neurological impairment has already occurred.

• Surgery + ATT leads to better outcomes in complex cases.

🌍 Global Note

• More common in developing countries, where TB is still widespread.

• Increasing in developed countries among immunocompromised populations.

🧭 Summary Chart

Feature	Details
Cause	Mycobacterium tuberculosis
Main symptoms	Back pain, fever, night sweats, weight loss
Complications	Kyphosis, paralysis, abscesses
Diagnosis	MRI, biopsy, TB tests
Treatment	Long-term ATT ± Surgery
Prognosis	Good if treated early

📚 Resources

• World Health Organization (WHO) TB guidelines

• CDC TB Factsheet

• National Institute for Health and Care Excellence (NICE) – UK TB management

• PubMed and medical journals for current studies

Would you like a treatment tracker, symptom diary, or a PDF guide on Pott’s disease for patient education? Happy to help with that too.

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