Potts disease

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 Definition
Aka: Tuberculous spondylitis

Refers to vertebral body and intervertebral

disc involvement with tuberculosis.

Percival Pott first described the disease in

1779 (English surgeon)

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 Epidemiology
20% of TB patients in the US have
extrapulmonary TB
Potts disease occurs in 5% of those with
extrapulmonary tuberculosis
45% with spinal involvement have associated
neurological deficits
1-2% of overall tuberculosis case
Usually targets hips, knees & spine

Much more common in the undeveloped world

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 Pathophysiology
Usually occurs via hematogenous spread
vertebral bodies vulnerable due to high blood flow
Lumbar and lower thoracic involvement more common
although can involve cervical vertebrae

Usually begins in anterior vertebral body

Neurological symptoms and cord compression from

abcesses, dural involvement or scarring tissue

Kyphosis develops from collapse of anterior spine (mainly

amongst thoracic vertebra)

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 Clinical findings
Usually presents as local pain
Can be indolent in onset with gradual worsening over
weeks to months
as worsens usually severe muscle spasm and rigidity
Systemic symptoms (fever, weight loss, etc) present
<40% of patients
60-90% with no evidence of extraspinal tuberculosis
Many (approx. 50%) present with neurologic symptoms
Kyphosis may be seen on presentation in advanced
disease

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 Gibbious Deformity anterior wedgind leads
to focal kyphosis.

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 Radiologic studies - Xray
Likely normal in early disease
First changes in anterior part of vertebral body
with demineralization of endplate
Next the opposite vertebral endplate will
become involved
With progression, anterior wedging develops
50% cases spare the disk space
May also show evidence of abcess
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 Radiologic studies - MRI
Show the anterior endplate involvement and
relative sparing of the disk an posterior
vertebral body in more detail
Can better demonstrate abcess formation
Best method for demonstrating nerve root
and spinal cord

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 Diagnostic studies
Purified protein derivative skin test (PPD)
90% will have positive PPD
May be negative in some immunocompetent
and many immunosuppressed patient

Biopsy and culture (with AFB smear) essential

to confirm diagnosis and rule out other causes

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 Treatment
Antibiotics
Four drug therapy (isoniazid, rifampin,
pyrazinamide & ethambutol)
May be more complicated if concerns of multi
drug resistant TB or if associated with
speticemia
At least 6 months of therapy
Usually responds well (even in sever cases)
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 Surgery
May play a role in spinal stabilization or abcess
drainage debridement
More role if advanced neurologic deficits,
worsening deficits on medical therapy or
severe kyphosis
Usually two procedure process first anterior
decompression and reconstruction then
posterior fusion
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 Become good at cheating and you never
need to become at anything else. -- Bansky

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