Pott’s Disease

Abstract

Pott’s disease, called as spinal tuberculosis (TB), is the most common but the most dangerous form of extrapulmonary infection in TB disease. Spinal involvement which commonly originates from the lungs occurs in less than 1% of patients with TB. Today, it has become an important health problem as a result of immigration of the patients from endemic geographic areas of the world to non-endemic areas. Unfortunately, the diagnosis is usually delayed owing to difficulty in diagnosis, and there are various challenges in the control of TB worldwide such as increased drug resistance. Imaging studies demonstrate vertebral body destruction with/without concomitant spinal and paraspinal abscess in thoracic, cervical and/or lumbar regions of the spine. Delay in diagnosis and treatment lead to spinal deformity with spinal cord compression. Therefore, it should be considered if patients present with classical neurological findings suggesting spinal cord or nerve root compression in clinical practice. Effective anti-TB drugs should be combined with conventional decompressive procedures in these patients. In the presence of abscess or spinal instability with/without kyphosis, removal of the infected necrotic material, bone grafting and instrumentation via anterior and/or posterior approach, is optimal for a stable sagittal alignment. Recently, new treatment strategies including closed interventional radiology procedures and percutaneous fixation have been described in patients with Pott’s disease for spinal cord decompression in the literature. In conclusion, the neurological involvement in patients with spinal TB is relatively benign when early surgery is combined with long-term anti-TB chemotherapy.