Pott's disease, or Pott disease, named for British surgeon Percivall Pott who first described the symptoms in 1799,[1]istuberculosis of the spine,[2][3] usually due to haematogenous spread from other sites, often the lungs. The lower thoracic and upper lumbar vertebrae areas of the spine are most often affected.
It causes a kind of tuberculous arthritis of the intervertebral joints. The infection can spread from two adjacent vertebrae into the adjoining intervertebral disc space. If only one vertebra is affected, the disc is normal, but if two are involved, the disc, which is avascular, cannot receive nutrients, and collapses. In a process called caseous necrosis, the disc tissue dies, leading to vertebral narrowing and eventually to vertebral collapse and spinal damage. A dry soft-tissue mass often forms and superinfection is rare.
Spread of infection from the lumbar vertebrae to the psoas muscle, causing abscesses, is not uncommon.[4]
Radiographic changes associated with Pott disease present relatively late. These radiographic changes are characteristic of spinal tuberculosis on plain radiography:
Lytic destruction of anterior portion of vertebral body
Half of the cases of musculoskeletal tuberculosis are Pott's Disease, of which 98% affect the anterior column. The disease can be attributed to 1.3 million deaths per year. There is a correlation between tuberculosis infections and cases of Pott's disease, as it's prevalent in areas where tuberculosis infections are common . Factors like socioeconomic status, habits, medical history, and interactions with people with tuberculosis can influence the rate of diagnosis.
Underdeveloped countries have a higher incidence rate of Pott's disease as it is associated with less ventilated rooms, crowded spaces, poorer hygiene, and less access to healthcare facilities. Increasing food security, reducing poverty, and improving living and working conditions will help to prevent infection and generally enhance the care of those sick.
Pott's disease is more common in the working-age population. It is becoming increasingly prevalent in older adults due to increased life expectancies, increased immunosuppressant use, chronic diseases like diabetes, and a rise in drug-resistant tuberculosis strains. In older populations, the disease is often misdiagnosed, often being disregarded for other degenerative diseases. Children's spines contain more cartilage, increasing the effect of spinal deformations caused by the disease.
Multidrug resistant tuberculosis poses a threat to people with Pott's disease, making it difficult to determine infection in people because of the paucibacillary symptoms of the disease. Cases of tuberculosis have been on the decline; however, infections of multidrug resistant tuberculosis have remained constant since the 1990s.
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, patients must take their medications exactly as prescribed.[2]
Immobilization of the spine region using different types of braces and collars
Physical therapy for pain-relieving modalities, postural education, and teaching a home-exercise program for strength and flexibility
Surgery may be necessary, especially to drain spinal abscesses or debride bony lesions fully or to stabilize the spine. A 2007 review found just two randomized clinical trials with at least one-year follow-up that compared chemotherapy plus surgery with chemotherapy alone for treating people diagnosed with active tuberculosis of the spine. As such, no high-quality evidence exists, but the results of this study indicates that surgery should not be recommended routinely and clinicians have to selectively judge and decide on which patients to operate.[5]
Thoracic spinal fusion with or without instrumentation as a last resort
Søren Kierkegaard may have died from Pott disease, according to professor Kaare Weismann and literature scientist Jens Staubrand[6]
Chick Webb, a swing-era drummer and band leader, was affected by tuberculosis of the spine as a child, which left him hunchbacked, and eventually caused his death.
Italian writer, poet, and philosopher Giacomo Leopardi had the disease.
American actor Pat Morita was hospitalized as a child with the disease, and when he recovered, was sent directly to an internment camp.
It features prominently in the book This Is a Soul, which chronicles the work of American physician Rick HodesinEthiopia.
Jane Addams, social activist and Nobel Peace Prize winner, had Pott disease.
Willem Ten Boom, brother of Corrie Ten Boom, died of tuberculosis of the spine in December 1946.[7]
Writer Max Blecher had Pott disease and wrote about the affliction.
Marxist thinker and Communist leader Antonio Gramsci had Pott disease which, together with the bad conditions of his incarceration in fascist Italy during the 1930s, contributed to his death.
Gavrilo Princip, who assassinated Archduke Franz Ferdinand of Austria, leading to World War I, died in prison of bone tuberculosis.
English writer Denton Welch (1915–1948) died of spinal tuberculosis after being involved in a motor accident (1935) that irreparably damaged his spine.
Max Blecher's semi-autobiographical novel Inimi cicatrizate (1937) is about a young man named Emanuel who is afflicted with Pott disease in a sanatorium, as is the Radu Jude film Scarred Hearts (2016), loosely based on it.
A. J. Cronin's story "Two Gentlemen of Verona," includes a character named Lucia with tuberculosis of spine.
InWilliam Golding's novel The Spire (1964), Jocelin, the dean who wanted a spire on his cathedral, probably dies as a result of the disease.
^Jutte PC, van Loenhout-Rooyackers JH. Routine surgery in addition to chemotherapy for treating spinal tuberculosis. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD004532. DOI: 10.1002/14651858.CD004532.pub2. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004532.pub2/abstract
Media related to Pott's disease at Wikimedia Commons
