Pott's Spine and Paraplegia

Abstract

Spinal tuberculosis is usually secondary to lung or abdominal involvement and may also be the first manifestation of tuberculosis. Spinal tuberculosis (often called Pott’s disease) is by definition, an advanced disease,
requiring meticulous assessment and aggressive systemic therapy. Physicians should keep the diagnosis in
mind, especially in a patient from a group with a high rate of tuberculosis infection. This review aims on
updating the knowledge on spinal tuberculosis and its management. Skeletal involvement has been reported
to occur in approximately 10% of all patients with extrapulmonary tuberculosis, and half of these patients
develop infection within the spinal column. Symptoms of spinal tuberculosis are back pain, weakness, weight
loss, fever, fatigue, and malaise. It is much more prone to develop neurological manifestation, paraplegia of
varying degree. The palpation of spinous process in routine clinical examination is the most rewarding clinical method and is an invaluable measure for early recognition. Diagnosis of spinal tuberculosis is made on
the basis of typical clinical presentation along with systemic constitutional manifestation and the evidence of
past exposure to tuberculosis or concomitant visceral tuberculosis. Magnetic resonance imaging can define
the extent of abscess formation and spinal cord compression. The diagnosis is confirmed through percutaneous or open biopsy of the spinal lesion. Surgery is necessary as an adjunct to antibiotic therapy if the vertebral infection produces an abscess, vertebral collapse, or neurologic compression. Some patients need aggressive supportive care owing to tuberculous meningitis or encephalopathy. Moreover, the importance of
immediate commencement of appropriate treatment and its continuation for adequate duration along with
the proper counseling of the patient and family members should not be underestimated for successful and
desired outcome.
Key Words: Tuberculosis, Pott’s spine, Paraplegia