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POTT’S DISEASE

-is a presentation of extrapulmonary tuberculosis that affects the spine, a kind of 

tuberculous arthritis of the intervertebral joints. Scientifically, it is called

tuberculous spondylitis. Pott’s disease is the most common site of bone infection

in TB; hips and knees are also often affected. The lower thoracic and upperlumbar vertebrae are the areas of the spine most often affected.

-which is also known as Pott’s caries, David's disease, and Pott's curvature.

• Causative organism: Mycobacterium tuberculosis.

• Spread: Haematogenous. (by blood)

• Commonly associated with: Debilitating diseases, AIDS, Drug addiction, Alcoholism.

SIGNS

• gibbus formation - pathognomonic sign

• There may be kyphosis. (spinal curvature)

• Muscle wasting.

• protective upright, stiff position.

• A psoas abscess (may present as a lump in the groin and resemble a hernia).

SYMPTOMS

The onset is gradual.

• Back pain is localised.• Restricted spinal movements.• Fever.• Night sweats.• Anorexia.• Weight loss.

DIAGNOSTIC PROCEDURE

Blood

• TLC: Leucocytosis.

• ESR: raised during acute stage.

Tuberculin skin test

• Strongly positive.

• Negative test does not exclude diagnosis.

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Aspirate from joint space & abscess

• Transparency: turbid.

• Colour: creamy.

• Consistency: cheesy.

• Fibrin clot: large.

• Mucin clot: poor.

• WBC: 25000/cc.mm.

Histology

• Shows granulomatous tubercle.

X-Ray spine

Early:

• Narrowed joint space.

• Diffuse vertebral osteoporosis adjacent to joint.

• Erosion of bone.

• Fusiform paraspinal shadow of abscess in soft tissue.

Late:

• Destruction of bone.

• Wedge-shaped deformity (collapse of vertebrae anteriorly).

• Bony ankylosis.

COMPLICATIONS 

• Vertebral collapse resulting in kyphosis.

• Spinal cord compression.

• Sinus formation.

• Paraplegia (so called Pott's paraplegia).

TREATMENT AND MEDICAL MANAGEMENT

Drug treatment (R.I.P.E.S. and other antibiotic) is generally sufficient for Pott’s disease,

with spinal immobilization if required. Surgery is required if there is spinal deformity or

neurological signs of spinal cord compression.

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Standard antituberculosis treatment is required.

Duration of antituberculosis treatment:

• If debridement and fusion with bone grafting are performed, treatment

can be for six months.• If debridement and fusion with bone grafting are NOT performed a

minimum of 12 months’ treatment is required.

It may also be necessary to immobilize the area of the spine affected by thedisease, or the person may need to undergo surgery in order to drain anyabscesses that may have formed or to stabilize the spine.

Other interventions include application of knight/ taylor brace, head halter

traction.

Surgery plays an important part in the management. It confirms the diagnosis, relievescompression if it occurs, permits evacuation of pus, and reduces the degree of 

deformation and the duration of treatment.

Surgery includes ADSF ( Anterior decompression Spinal fusion).

NURSING CARE MANAGEMENT

• Provide bed rest to avoid unnecessary body energy expenditure.

• Assess for pain and provide analgesics as prescribed.• Proper care of traction.• Reposition the client every 2hrs.• Proper care of thoracostomy tube (milking technique) for continuous flow of secretion.• Encourage deep breathing exercise to promote lung expansion.• Do passive range of motion exercise (ROM).• Instruct diet high in protein and fiber.

• Increase fluid intake.• Provide comfort.

P atient should be reminded to attend check-ups at the nearest…

O rthopedic center.

T reatment shoud be taken in a…

T imely manner.

S ight any symptoms other than usual and report it to the physician

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 POTT’S DISEASE

KNIGHT/TAYLOR BRACEREFERENCES:

http://www.hpathy.com 

www.google.com 

www.wikipedia.com