INTRODUCTION Pott's disease is tuberculosis of the spine, the commonest site of bone and joint tuberculosis, being involved

in more than half the cases. A progressively destructive disease resulting from the activity of mycobacterium tuberculosis in the bone or articular structures. It is

caused by tuberculous infection in another part of the body , such as lungs or lymph nodes. Tuberculosis (TB) of the spine also known as Potts disease, Potts Caries, David's disease, Tuberculosis spondylitis and Pott's curvature.

Tuberculous involvement of the spine has the potential for serious morbidity, including permanent neurologic deficits and severe deformity . medical treatment of combined medical and surgical strategies can control the disease in most patients. In Philippines it is common in male and primarily occurs in adults, in countries with higher rates of

infection it mainly occurs in children. Commonest in groups whose living conditions are substandard Potts curvature is the most common site of bone infection in TB. A person with Pott's disease often develops kyphosis, which results in a hunchback. In some cases, a person with Pott's disease may also develop paralysis,

referred to as Potts paraplegia, when the spinal nerves become affected by the curvature. The disease progresses slowly. Signs and symptoms include: back pain, fever, night sweats, anorexia, weight loss, and easy fatigability. Gibbus formation is the pathognomonic sign of this disease. ANATOMY

The vertebral column provides structural support for the trunk and surrounds and protects the spinal cord. The vertebral column also provides attachment points

for the muscles of the back and ribs. The vertebral disks serve as shock absorbers during activities such as walking, running, and jumping. They also allow the spine to flex and extend

PATHOPHYSIOLOGY
PRECIPITATING FACTORS PREDISPOSING FACTORS

- Non-compliance to medicines - Continuous exposure to M.Tubeculosis - Malnutrition - Socio-economic status

- PTB diagnosed

MEDICATIONS HERE:

Exposure to Mycobacterium Tubeculosis Intermittent fever, upper back pain, night sweats, poor appetite, weight loss.

Primary Pulmonary Tuberculosis

Spread of Mycobacterium Tuberculosis

ExtrapulmonaryTuberculosis

Progressive bone Persistent back pain Infection spreads to the intervertebral disc destruction in the T7-T9 of the spine

Intervertebral Collapse

Caseation takes place

Gibbus formation between T4-T7 or T7-T9

Spinal cord depression

Neurological effects and lower motor defficits

Pott's parplegia

MEDICAL MANAGEMENT/ INTERVENTION

Anti-tuberculosis treatment is required (treatment can be for six months. If debridement and fusion with bone grafting are NOT performed a minimum of 12 months treatment is required)

Isoniazid and rifampicin should be administered during the whole course of therapy. Additional drugs are administered during the first 2 months of therapy.

 It may also be necessary to immobilize the area of the spine affected by the disease or the person. Surgery is required if there is spinal deformity or neurological signs of spinal cord compression.

Application of knight/ Taylor brace, head halter traction.

DIAGNOSIS Tuberculin skin test (purified protein derivative [PPD]) The erythrocyte sedimentation rate (ESR) Radiography CT Scanning

 MRI Bone biopsy.

GENERAL NURSING MANAGEMENT Bed rest. Immobilisation of affected joint by splintage. Encourage high protein diet. Drainage of abscess. Surgical decompression.

Physiotherapy.