Pott’s disease (PD), is also known as tuberculosis spondylitis. From olden history, TB (tuberculosis) has been recognized as a disease. This was referred to as “Yakshama” from ancient Indian medical writings such as the Charaka Samhita and Sushruta Samhita as old as 1000 to 600 BCE.
Sir Percival Pott first documented the kyphotic deformities and neurologic deficits that clinically characterize the tubercular illness of the spine in European sufferers in 1779.
Later, in the nineteenth and twentieth centuries, the identification of the causative pathogenic bacteria (Mycobacterium tuberculosis), the creation of the BCG (Bacillus Calmette-Guerin) vaccine, and improvements in diagnostic techniques, surgical techniques, and chemotherapeutic drugs had greatly transformed the treatment of spinal TB and given humanity far added protection against this crippling disease.
Due to an ” international migration trend,” the disease has recently demonstrated a substantial recurrence in affluent countries, especially among the immunosuppressed population. The global community has faced significant difficulty as a result.
Over the past few decades, there has been a concerning rise in the incidence of multi-drug resistant strains of bacteria of tuberculosis in underdeveloped countries. These factors explain why the illness is still a serious problem in the world of public health today.
Epidemiology
EPTB (Extrapulmonary tuberculosis) affects three percent of people, ten percent of whom have skeletal tuberculosis. Fifty percent of skeletal TB infections are caused by spinal tuberculosis. 10.4 million new tuberculosis cases were recorded by the WHO in 2016, with 46.5 percent of those infections coming from the Southeast Asian Region solely.
23 percent of the world’s tuberculosis burden originated in India. From 2000 to 2015, the WHO reported a rise in global migration between 173 to 244 million people. And in the affluent world, the recent recurrence of tuberculosis is partly due to this worldwide pattern of migration that is on the rise.
Anatomy
Pathophysiology
Spinal tuberculosis typically develops as a result of hematogenous dissemination from an initial infected location (generally, the lungs). Because the paradiscal arteries often support the subchondral bone along both sides of the disc, the paradiscal region is the most frequently affected vertebral region.
Other involvement patterns include non-osseous involvement (exhibiting the abscess), posterior involvement, and central involvement (with primary involvement of the vertebral body). Spinal instability and kyphotic deformity are caused by cumulative vertebral deterioration.
Etiology
Mycobacteriaceae genus complex taxonomic category is the causative pathogen of tuberculosis. There are about sixty species, with M. tuberculosis being the most prevalent variety.
These bacilli are meticulous, slowly developing, as well as aerobic. M. Bovis, M. africanum, M. microti, and M. avium are some non-tubercular mycobacterium types that are harmful to people.
The tuberculosis bacilli can survive for a very long time in a dormant state, but when the right conditions are present again, they prefer to grow about every fifteen to twenty hours.
A granulomatous immune reaction brought on by the infection is frequently characterized by lymphocytes, large Langhans-type cells, epithelioid cells, and caseating necrosis.
Long-term contact with infected individuals, immunodeficiency factors (AIDS, alcoholism, drug misuse), malnutrition, overcrowding, a poorer socioeconomic standing, and poverty are a few common triggers for tuberculosis.
Stage I: Pre-destructive stage; curvature straightening, perivertebral muscular spasm, scintiscan hyperemia (Lasting less than three months)
Stage II: Early stages of degeneration include disc space loss, paradiscal erosion, knuckle only about 10 degrees, marrow edema on MRI, and cavitations or erosions on CT. (Lasting two to four months)
Stage III: Angular mild kyphosis with 2 to 3 affected vertebrae and a 10 to 30-degree kyphosis (Lasting three to nine months)
Stage IV: Angular moderate kyphosis with 2 to 3 affected vertebrae and a 30 to 60-degree kyphosis (Lasting six to twenty-four months)
Stage V: Angular severe kyphosis, involving three or more vertebrae and then a kyphosis of at least 60 degrees (Lasting more than twenty-four months)
The key to a successful outcome in the Pott’s spine is early identification and therapy.
The prognosis is generally worse for severe tuberculous spine illness (with concomitant deformity, unstable, or neurological impairment) than for uncomplicated illness.
Age (relatively poor results at the extremes of age), immunodeficiency factors (AIDS, alcoholism, drug misuse), malnutrition, overcrowding, a poorer socioeconomic standing, and poverty are additional significant prognostic variables.
A key contributing reason to medication failure in tuberculosis is low adherence and low tolerance to Anti-tubercular treatment (including abnormal liver functioning).
Pott paraplegia risk factors for poor prognosis
Grade of disease (tight junctions’ vertebral level), pan-vertebral participation, protracted neuron deficiency, speed of advancement, severity, kind of compression (abscess vs granuloma), and the existence of spinal alterations are all factors to consider.
Deformity progress has a poor prognosis
Age under ten years, a kyphosis angle more than thirty degrees, three or even more affected vertebrae, 1.5 or more vertebral bodies lost, pan-vertebral illness, and signs of instability
Clinical History
Physical Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
Medication
Future Trends
Media Gallary
References
https://www.ncbi.nlm.nih.gov/books/NBK538331/
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Pott’s disease (PD), is also known as tuberculosis spondylitis. From olden history, TB (tuberculosis) has been recognized as a disease. This was referred to as “Yakshama” from ancient Indian medical writings such as the Charaka Samhita and Sushruta Samhita as old as 1000 to 600 BCE.
Sir Percival Pott first documented the kyphotic deformities and neurologic deficits that clinically characterize the tubercular illness of the spine in European sufferers in 1779.
Later, in the nineteenth and twentieth centuries, the identification of the causative pathogenic bacteria (Mycobacterium tuberculosis), the creation of the BCG (Bacillus Calmette-Guerin) vaccine, and improvements in diagnostic techniques, surgical techniques, and chemotherapeutic drugs had greatly transformed the treatment of spinal TB and given humanity far added protection against this crippling disease.
Due to an ” international migration trend,” the disease has recently demonstrated a substantial recurrence in affluent countries, especially among the immunosuppressed population. The global community has faced significant difficulty as a result.
Over the past few decades, there has been a concerning rise in the incidence of multi-drug resistant strains of bacteria of tuberculosis in underdeveloped countries. These factors explain why the illness is still a serious problem in the world of public health today.
EPTB (Extrapulmonary tuberculosis) affects three percent of people, ten percent of whom have skeletal tuberculosis. Fifty percent of skeletal TB infections are caused by spinal tuberculosis. 10.4 million new tuberculosis cases were recorded by the WHO in 2016, with 46.5 percent of those infections coming from the Southeast Asian Region solely.
23 percent of the world’s tuberculosis burden originated in India. From 2000 to 2015, the WHO reported a rise in global migration between 173 to 244 million people. And in the affluent world, the recent recurrence of tuberculosis is partly due to this worldwide pattern of migration that is on the rise.
Spinal tuberculosis typically develops as a result of hematogenous dissemination from an initial infected location (generally, the lungs). Because the paradiscal arteries often support the subchondral bone along both sides of the disc, the paradiscal region is the most frequently affected vertebral region.
Other involvement patterns include non-osseous involvement (exhibiting the abscess), posterior involvement, and central involvement (with primary involvement of the vertebral body). Spinal instability and kyphotic deformity are caused by cumulative vertebral deterioration.
Mycobacteriaceae genus complex taxonomic category is the causative pathogen of tuberculosis. There are about sixty species, with M. tuberculosis being the most prevalent variety.
These bacilli are meticulous, slowly developing, as well as aerobic. M. Bovis, M. africanum, M. microti, and M. avium are some non-tubercular mycobacterium types that are harmful to people.
The tuberculosis bacilli can survive for a very long time in a dormant state, but when the right conditions are present again, they prefer to grow about every fifteen to twenty hours.
A granulomatous immune reaction brought on by the infection is frequently characterized by lymphocytes, large Langhans-type cells, epithelioid cells, and caseating necrosis.
Long-term contact with infected individuals, immunodeficiency factors (AIDS, alcoholism, drug misuse), malnutrition, overcrowding, a poorer socioeconomic standing, and poverty are a few common triggers for tuberculosis.
Stage I: Pre-destructive stage; curvature straightening, perivertebral muscular spasm, scintiscan hyperemia (Lasting less than three months)
Stage II: Early stages of degeneration include disc space loss, paradiscal erosion, knuckle only about 10 degrees, marrow edema on MRI, and cavitations or erosions on CT. (Lasting two to four months)
Stage III: Angular mild kyphosis with 2 to 3 affected vertebrae and a 10 to 30-degree kyphosis (Lasting three to nine months)
Stage IV: Angular moderate kyphosis with 2 to 3 affected vertebrae and a 30 to 60-degree kyphosis (Lasting six to twenty-four months)
Stage V: Angular severe kyphosis, involving three or more vertebrae and then a kyphosis of at least 60 degrees (Lasting more than twenty-four months)
The key to a successful outcome in the Pott’s spine is early identification and therapy.
The prognosis is generally worse for severe tuberculous spine illness (with concomitant deformity, unstable, or neurological impairment) than for uncomplicated illness.
Age (relatively poor results at the extremes of age), immunodeficiency factors (AIDS, alcoholism, drug misuse), malnutrition, overcrowding, a poorer socioeconomic standing, and poverty are additional significant prognostic variables.
A key contributing reason to medication failure in tuberculosis is low adherence and low tolerance to Anti-tubercular treatment (including abnormal liver functioning).
Pott paraplegia risk factors for poor prognosis
Grade of disease (tight junctions’ vertebral level), pan-vertebral participation, protracted neuron deficiency, speed of advancement, severity, kind of compression (abscess vs granuloma), and the existence of spinal alterations are all factors to consider.
Deformity progress has a poor prognosis
Age under ten years, a kyphosis angle more than thirty degrees, three or even more affected vertebrae, 1.5 or more vertebral bodies lost, pan-vertebral illness, and signs of instability
https://www.ncbi.nlm.nih.gov/books/NBK538331/
medtigo
Pott’s disease
Updated :
September 17, 2022
Pott’s disease (PD), is also known as tuberculosis spondylitis. From olden history, TB (tuberculosis) has been recognized as a disease. This was referred to as “Yakshama” from ancient Indian medical writings such as the Charaka Samhita and Sushruta Samhita as old as 1000 to 600 BCE.
Sir Percival Pott first documented the kyphotic deformities and neurologic deficits that clinically characterize the tubercular illness of the spine in European sufferers in 1779.
Later, in the nineteenth and twentieth centuries, the identification of the causative pathogenic bacteria (Mycobacterium tuberculosis), the creation of the BCG (Bacillus Calmette-Guerin) vaccine, and improvements in diagnostic techniques, surgical techniques, and chemotherapeutic drugs had greatly transformed the treatment of spinal TB and given humanity far added protection against this crippling disease.
Due to an ” international migration trend,” the disease has recently demonstrated a substantial recurrence in affluent countries, especially among the immunosuppressed population. The global community has faced significant difficulty as a result.
Over the past few decades, there has been a concerning rise in the incidence of multi-drug resistant strains of bacteria of tuberculosis in underdeveloped countries. These factors explain why the illness is still a serious problem in the world of public health today.
EPTB (Extrapulmonary tuberculosis) affects three percent of people, ten percent of whom have skeletal tuberculosis. Fifty percent of skeletal TB infections are caused by spinal tuberculosis. 10.4 million new tuberculosis cases were recorded by the WHO in 2016, with 46.5 percent of those infections coming from the Southeast Asian Region solely.
23 percent of the world’s tuberculosis burden originated in India. From 2000 to 2015, the WHO reported a rise in global migration between 173 to 244 million people. And in the affluent world, the recent recurrence of tuberculosis is partly due to this worldwide pattern of migration that is on the rise.
Spinal tuberculosis typically develops as a result of hematogenous dissemination from an initial infected location (generally, the lungs). Because the paradiscal arteries often support the subchondral bone along both sides of the disc, the paradiscal region is the most frequently affected vertebral region.
Other involvement patterns include non-osseous involvement (exhibiting the abscess), posterior involvement, and central involvement (with primary involvement of the vertebral body). Spinal instability and kyphotic deformity are caused by cumulative vertebral deterioration.
Mycobacteriaceae genus complex taxonomic category is the causative pathogen of tuberculosis. There are about sixty species, with M. tuberculosis being the most prevalent variety.
These bacilli are meticulous, slowly developing, as well as aerobic. M. Bovis, M. africanum, M. microti, and M. avium are some non-tubercular mycobacterium types that are harmful to people.
The tuberculosis bacilli can survive for a very long time in a dormant state, but when the right conditions are present again, they prefer to grow about every fifteen to twenty hours.
A granulomatous immune reaction brought on by the infection is frequently characterized by lymphocytes, large Langhans-type cells, epithelioid cells, and caseating necrosis.
Long-term contact with infected individuals, immunodeficiency factors (AIDS, alcoholism, drug misuse), malnutrition, overcrowding, a poorer socioeconomic standing, and poverty are a few common triggers for tuberculosis.
Stage I: Pre-destructive stage; curvature straightening, perivertebral muscular spasm, scintiscan hyperemia (Lasting less than three months)
Stage II: Early stages of degeneration include disc space loss, paradiscal erosion, knuckle only about 10 degrees, marrow edema on MRI, and cavitations or erosions on CT. (Lasting two to four months)
Stage III: Angular mild kyphosis with 2 to 3 affected vertebrae and a 10 to 30-degree kyphosis (Lasting three to nine months)
Stage IV: Angular moderate kyphosis with 2 to 3 affected vertebrae and a 30 to 60-degree kyphosis (Lasting six to twenty-four months)
Stage V: Angular severe kyphosis, involving three or more vertebrae and then a kyphosis of at least 60 degrees (Lasting more than twenty-four months)
The key to a successful outcome in the Pott’s spine is early identification and therapy.
The prognosis is generally worse for severe tuberculous spine illness (with concomitant deformity, unstable, or neurological impairment) than for uncomplicated illness.
Age (relatively poor results at the extremes of age), immunodeficiency factors (AIDS, alcoholism, drug misuse), malnutrition, overcrowding, a poorer socioeconomic standing, and poverty are additional significant prognostic variables.
A key contributing reason to medication failure in tuberculosis is low adherence and low tolerance to Anti-tubercular treatment (including abnormal liver functioning).
Pott paraplegia risk factors for poor prognosis
Grade of disease (tight junctions’ vertebral level), pan-vertebral participation, protracted neuron deficiency, speed of advancement, severity, kind of compression (abscess vs granuloma), and the existence of spinal alterations are all factors to consider.
Deformity progress has a poor prognosis
Age under ten years, a kyphosis angle more than thirty degrees, three or even more affected vertebrae, 1.5 or more vertebral bodies lost, pan-vertebral illness, and signs of instability
https://www.ncbi.nlm.nih.gov/books/NBK538331/
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