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Pott's Disease

TB of the spine, known as Pott's spine, most commonly affects children and adolescents between ages 1-20. It spreads from a primary lung infection through the bloodstream and initially affects the thoracolumbar region of the spine. This can lead to angular kyphosis, nerve compression, and paraplegia. X-rays show bone destruction, fractures, and abscesses. Treatment involves anti-TB drugs for 6-18 months combined with surgical debridement and reconstruction for spinal stability.

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Shashi Kant
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31 views19 pages

Pott's Disease

TB of the spine, known as Pott's spine, most commonly affects children and adolescents between ages 1-20. It spreads from a primary lung infection through the bloodstream and initially affects the thoracolumbar region of the spine. This can lead to angular kyphosis, nerve compression, and paraplegia. X-rays show bone destruction, fractures, and abscesses. Treatment involves anti-TB drugs for 6-18 months combined with surgical debridement and reconstruction for spinal stability.

Uploaded by

Shashi Kant
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Pott's Spine (TB of Spine)

Introduction
 TB spine forms the 50-60% of the total incidence of
skeletal TB.

 Disease of childhood and adolesence, most


common in 1-20 years age group.

 The most common level of the lesion is in thoraco-


lumbar level.
Pathology
 The disease affects the spine secondarily from a
primary focus in the lungs or mediastinal glands
through the blood stream.

 Sites of lesion:
 Para-discal lesion
 Central body lesion
 Anterior type
 Appendicial type
Pathology
 The initial focus is in a vertebral body, near the
disc, it soon spreads across the disc, the disc is
infected secondarily which it destroys to involve the
neighboring vertebral body.

 The erosion of the inter-vertebral discs of


contiguous vertebra lead to disc space narrowing.
Clinical features

 A long history with insidious onset


 Localized back pain: slight dull ache, be worse after
standing, walking
 Deformity or gibbus: angular kyphosis-a sharp
deformity at T-L spine
 Protective paraspinal spasm
 Paraplegia
 Cold abscess
Pott’s paraplegia
 Pressure on the spinal cord may occur at any stage
in the course of TB in the thoracic spine, it may be
compressed by soft inflammatory material such as
abscess, a caseaous mass, granulation tissue, and a
sequestrated disc;

 Or by hard solid material such as bony sequestrum,


occasionally, fibrous tissue is the compressing
agent.
Clinical features

 The onset is insidious manifesting itself either by motor


weakness or sensory impairement in lower limbs, or
dysfunction of bladder or bowel.

 Clumsiness, incoordination, weakness are early symptoms,


voluntary movement ability decreased, muscle tone
increased and tendon reflexes brisk.

 Clonus and extensor plantar reaction,

 Paraesthesia or numbness may occur.


X-ray findings:

 Bone destruction, compression fracture,


kyphosis, joint space narrowing and abscess
may be present.
X-ray findings:
X-ray findings:
Treatment
 The systemic treatment with anti-tuberculosis medications
before and after the surgical debridement, the careful
debridement of the entire focus of infection, and the
successful method to reconstruct for spinal stability are the
key aspects in the treatment of spinal tuberculosis.
Treatment
 For decision making and management of spinal TB, it can be
broadly classified as two groups of lesions: those with
neurologic complications and those without.
 In patients without neurologic deficit, medical therapy is the
treatment of choice and surgical intervention may be needed
in relatively few cases. In cases with neurologic
complications, medical therapy is the first choice again but
when indicated, combination of medical and surgical
treatments yield the best results.
Treatment

 Combination of rifampicin, isoniazid, ethambutol,


and pyrazinamide for two months followed by
combination of rifampicin and isoniazid for a total
period of 6, 9, 12 or 18 months is the most frequent
protocol used for treatment of spinal TB.
TB of the hip

 Incidence: male: female=2 : 1


 Osseous focus: acetabulum, femoral head and neck
and the joint cavity
TB of the hip

 Once arthritis develops, destruction is rapid.


 The femoral head may also be destroyed
permitting the pathological dislocations with
muscle spasm.
 Cold abscess may point anteriorly in the femoral
triangle and posteriorly below the lower margin of
gluteus maximus.
Clinical features

 Early slight pain in the groin or thigh


 The pain often radiates down to the knee because
the capsule of the hip joint shares the same nerve
innervation.
 Later pain is more severe and may make the child
wake from the sleep
 Limp – is partly due to pain and muscle spasm (early
stage)
 Deformity
Clinical features
 Deformity:
 Early stage- the initial abduction, flexion and external
rotation deformity may appear owing to synovitis and
distension of the joint capsule.

 Later stage- adduction, flexion and internal rotation


deformity which resulted from the combined effects of
muscle pull and bone destruction.
x-ray
Treatment

 An intensive course of anti-tuberculosis agents are


essential,

 Complete rest is continued for 6 months, skin


traction or plaster are used sometimes.

 When there is obvious bone destruction, clearance


of the hip joint with removal of TB tissue give the
best result, later on arthrodesis may be performed.

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