2.  Tb of the spine or Pott’s disease is a
presentation of extrapulmonary
tuberculosis that affects the spine,
 a kind of tuberculous arthritis of the
intervertebral joints.
 The lower thoracic and upper lumbar
vertebrae are the areas of the spine most
often affected.
 Scientifically, it is called tuberculous
spondylitis

5.  Pott’s disease results from haematogenous
spread of tuberculosis from other sites, often
pulmonary.
 The infection then spreads from two adjacent
vertebrae into the adjoining intervetebral disc
space.
 If only one vertebra is affected, the disc is
normal, but if two are involved, the disc, which
is avascular, cannot receive nutrients and
collapses.
 The disc tissue dies leading to intervertebral
space narrowing and eventually to vertebral
collapse and spinal damage.

6.  Incidence
 In the United States, bone and soft
tissue tuberculosis accounts for
approximately 10% of extrapulmonary
TB cases and between 1% and 2% of
total cases.
 Of these cases, Pott’s disease is the
most common manifestation of
musculoskeletal TB, accounting for
approximately 40-50%.

7.  Ethnicity
Data from the United States show that
musculoskeletal tuberculosis primarily
affects African Americans, Hispanic
Americans, Asian Americans, and
foreign-born individuals.

8.  Gender
Although some studies have found that
Pott’s disease does not have sexual
predilection, the disease is more
common in males.
 The male to female ratio is reportedly
1.5-2:1.

9.  Age
In the United States and other
developed countries, Pott’s disease
occurs primarily in adults.
 In underdeveloped countries which have
higher rates of Pott’s disease,
involvement in young adults and older
children predominates.

10.  back pain
 Fever
 Tenderness on furrow of the back
 night sweating
 anorexia
 Spinal mass, sometimes associated with
numbness, paraesthesia, or muscle
weakness of the legs
 Restriction of spinal movements

12.  blood tests
 elevated erythrocyte sedimentation rate
>100 mm/h
 Mantoux test results are positive in 84-
95% of patients with Pott disease who
are not infected with HIV.

13.  radiographs of the spine:
 Radiographic changes associated with
Pott’s disease present relatively late.
 Lytic destruction of anterior portion of
vertebral body
 Increased anterior wedging
 Collapse of vertebral body
 Reactive sclerosis on a progressive lytic
process
 Enlarged psoas shadow with or without
calcification

17.  bone scan
 CT of the spine
 bone biopsy
 MRI

19.  Vertebral collapse resulting in kyphosis
 Spinal cord compression
 Nerve root compression
 sinus formation
 paraplegia (so called Pott's paraplegia)
 Disc herniation
 Psoas abscess
 Cauda equina syndrome

20.  The medical management is mainly
focused to eliminate the infection and
pain suppression
 antituberculous drugs(rifampicin,
isoniazid,pyrazinamide,ethambutol and
streptomycin
 Analgesics(pethidine,diclofenac)

21.  Surgery may be necessary, especially to
drain spinal abscesses or to stabilize the
spine
 Thoracic spinal fusion is done as a last
resort

22.  Muscle strength mx:
 Walking Program
 Aerobic Exercise
 Trunk Strengthening
 Spinal stabilization excersizes

23.  Pain mx:
 Hydrotherapy Therapy
 TENS
 Interferential therapy

24.  Excersizes focusing on muscles of the
back can strenghthen them preventing
further kyphosis
 Electrotherapy modalities are usefull in
alleviating pain

25.  Since physio mx is mainly focused on
pain and muscle strength it can’t :
 Reverse the bone destruction that takes
place
 The necrosis that would have occurred
to ivds
 stop the progression of the diseases

26.  Modalities like ift can’t be used directly
on the vertebral column hence its effects
are not maxmal
 Continued exercesizes might give a
muslce cast in the deformed position

27.  Prognosis is variable, some individuals will
recover completely,particularly if the
infection has been cured.
 Those requiring longterm suppressive
therapy may develop recurrences if drug
therapy is not maintained
 Although spinal fusion maybe effective in
relieving pain discomfort depending on the
severity of the symptoms, surgery will not
however treat the underlying disease

28.  In the past prior to discovery of drugs for
Tb, 20% of patients died and 30% had
recurrence of their symptoms.

29.  Apley’s orthopaedic textbook, Cleveland
clinic journal of
medicine,www.physiopedia.com,
www.pubmed.com.