Pott’s Disease

Definition – Tuberculosis of the vertebral column is called Pott’s disease.

Incidence
Age – Between 3 to 5 years.
Site – Most common in the lower thoracic region or thoraco-lumbar junctional region.
Route of Infection – Blood-borne infection is the commoner type.

Types

1. Central – Starting as diffuse osteomyelitis in the middle of the body.
2. Metaphyseal Tuberculosis – Where disease arises near the epiphysis of the bone and therefore close to the intervertebral disc.
3. Anterior or Periosteal Variety.
4. Appendiceal Tuberculosis.

Clinical Features

1. Constitutional Features – Like deterioration in general health, loss of weight, poor appetite, lassitude and evening rise of temperature.
2. Pain – Initially, it is dull aching in nature while standing or jolting. Gradually, it becomes acute and stabbing in character, situated over the affected vertebrae.
3. Stiffness – Patient’s spine becomes increasingly stiff as the disease progresses.
4. Swelling – Reveals spinal carries.

Physical Signs
General Examination – May demonstrate other signs of tuberculous infection. The patient is malnourished.

• Attitude and Gait –
  • In upper cervical disease, head position is like that of torticollis, but face is not rotated.
  • In lower cervical disease, head moves backwards and to one side.
  • In upper thoracic disease, shoulders are raised and arms are drawn backwards.
  • In lower thoracic disease, thorax and head move backwards and the abdomen moves forward.
• Spinal Deformities – Appear late in the disease:
  • Kyphosis.
  • Scoliosis.
  • Lordosis.
• Rigidity of the Spine.
• Examination for Cold Abscess.

Investigations
X-ray ( AP and lateral view) of the spine.

Treatment

1. Appropriate symptomatic treatment.
2. Surgery – If no sign of improvement is noticed after 6 to 8 weeks of the disease, spinal fusion operation is advised –
   1. Albee’s operation.
   1. Brittain’s operation.

Reference: A Handbook of Surgery by Dr Mansi Sharma