(Pott’s disease) - commonest form of skeletal TB which often causes complete destruction of the intervertebral disc with partial destruction of two adjacent vertebrae which is most marked anteriorly. The destruction may involve a single or multiple spinal segments of dorsal spine (75%), cervical spine (<10%) or (rarely) lumbar spine.
Causes
• A chronic infection caused by Mycobacteria
Clinical features
• Commonest in young adults
• Back stiffness due to muscle spasms
• Anterior collapse of affected vertebrae leads to visible deformity (angular kyphosis or gibbus)
• Localised tenderness, localised abscess
• Weakness of legs
• Visceral dysfunction
• In thoracic spinal TB: pus formation produces a paravertebral abscess
• In lumbar spinal TB: pus tracks along the iliopsoas muscles and points in the groin
• In thoracic or thoraco-lumbar spinal TB: spinal cord involvement results in (Pott’s) paraplegia
• Signs of spinal cord compression (Pott’s paraplegia) or nerve root lesion
Differential diagnosis
• Staphylococcal spondylitis
• Brucellosis
• Metastatic lesion
Investigations/ Diagnosis
• Adequate history & careful examination
• X-ray spine shows:
- disc space narrowing
- paravertebral shadow
- single/multiple vertebral involvement
- destruction lesions of 2 or more vertebrae without new bone formation
- destruction of vertebral end-plates
- expanding inflammatory mass
• Blood:
- WBC (within normal limits),
- lymphocyte:monocyte ratio is approx 5:1
- ESR = 25mm/hr (Westergreen method)
• Skin tuberculin test (not specific)
• Tissue biopsy:
- ZN staining of aspirate
- for needle aspirate guided by fluoroscopy, open biopsy and guinea pig inoculations, refer to Regional Referral Hospital
Management
HC4
Rest the spine
Fit a spinal corset or plaster jacket for pain relief
All patients (see p90 for explanation of drug regimes)
2 SHRZ / 7 HR
Alternative regime:
2 EHRZ / 7 HR
If patient has progressive paraplegia despite adequate conservative treatment:
Refer for specialist surgery to regional or national referral hospital
