Spinal tuberculosis, also known as Pott's disease, is caused by tuberculosis infection of the spine. It most commonly affects the thoracic and lumbar regions of the spine. Diagnosis involves imaging like x-rays, CT scans, and MRI (the gold standard) combined with clinical signs and symptoms. Treatment depends on the severity and extent of spinal destruction, ranging from antibiotic therapy alone for early or localized disease to surgical interventions like debridement and spinal fusion for advanced cases involving abscesses or neurological deficits. Proper diagnosis and treatment are important to achieve resolution of symptoms and prevent long-term complications like kyphosis and paraplegia.

1. Spinal tuberculosis
Dr Muhammad Ijaz wazir
Tmo Orthopedic B ward HMC

2. Introduction
• Known by many names: spinal tuberculosis,
tuberculous spondylitis, Pott disease or Pott’s
disease
• First described in 1782 by Percival Pott, a British
orthopedic surgeon

3. Pott Disease: Epidemiology
• Pott disease is common in the developing countries
• Skeletal tuberculosis Accounts for 10% of all cases
of extrapulmonary TB
• Targets the hips, knees, spine
• Spinal tuberculosis is most common, accounts for
50% all skeletal TB cases
• men & women equally affected
• Targets thoracic & lumbar vertebrae

4. Pott Disease: Pathophysiology
– Tuberculous bacilli infiltrates the spine via Hematogenous spread
through the dense vasculature of cancellous bone of the anterior
vertebral bodies
– Lymphatic spread from para‐aortic lymph nodes possible but rare
– Up to 75% of infected individuals develop a soft tissue infection
Commonly occurs in the psoas muscle
– Left untreated, degeneration and inflammation of the vertebrae
causes Herniation into the cord space , cord compression
– Kyphosis , gibbous (severe kyphosis)
– Paraplegia

5. CLINICAL FEATURES
• Slowly progressive constitutional symptoms are
predominant in the early stages of the disease,
including weakness, malaise, night sweats, fever,
and weight loss, Pain is a late symptom associated
with bone collapse and paralysis.
• Cervical involvement can cause hoarseness because
of recurrent laryngeal nerve paralysis, dysphagia,
and respiratory stridor (known as Millar asthma).

6. Diagnosis
• History
• Physical examination
• Laboratory investigations
• Plain x rays of the spine
• CT of the spine
• MRI of the spine
• Biopsy
• Bone scan
• Ultra sound scan

7. Pott Disease: Lab FINDINGS
• Laboratory studies suggest chronic disease.
Findings include anemia, hypoproteinemia, and
mild elevation of ESR and CRP. Skin testing may
be helpful but is not diagnostic. The test is
contraindicated in patients with prior
tuberculous infection because of the risk of skin
slough from an intense reaction and is not
useful in patients with suspected reactivation of
the disease.

8. Radiographs: General Features
– Features of Pott’s on radiograph includeSigns of
infection with lytic lucencies in anterior portion of
vertebrae
– Disk space narrowing
– Erosions of the endplate
– Sclerosis resulting from chronic infection
– Compression fracture
– Continuous vertebral body collapse
– Kyphosis; gibbous (severe kyphosis)

11. CT: Features
Soft tissue findings Abscess with calcification is
diagnostic of spinal TB; CT is excellent modality
to visualize soft tissue calcifications
Pattern and severity of bony destruction Pattern of
vertebral body destruction, osteolytic, localized
and sclerotic, and subperiosteal
Used to guide needle in percutaneous needle biopsy
of paraspinal abscess

14. MRI: Features
• Highly sensitive and specific for spinal TB
• Provides early detection
• Best to distinguish exact extent of spinal cord
and soft tissue involvement
• Features Edema of vertebrae and disk space
• Signs of spinal compromise i.e. cord
compression

15. MRI Features

16. MRI features

17. Differential Diagnosis
• Pyogenic & fungal infections
• Secondary metastatic disease
• Primary bone tumors
• Sarcoidosis

18. Pott Disease: Treatment
• Various imaging modalities are useful in
determining extent of disease.
• Treatment options then depend on the
degree of spinal destruction

19. Conservative Treatment
• Early Disease:
• Treat with a four drug regimen for six to twelve
months
• Common antibiotics are Rifampin, Isoniazid,
Pyrazinamide, Ethambutol
• Most individuals experience full resolution of
symptoms with appropriate anti‐tuberculosis
treatment

20. Surgical Interventions
• Late Disease:Loosely defined by neurologic
deficits, spinal kyphosis >40%, or failure of
medical therapy
• Surgical debridement, abscess drainage,
and/or vertebral fusion and spinal fixation in
addition to antibiotics

21. Treatment
• Depends upon the type of lesion
• Type 1 A
• The lesion is localised to one vertebra & one
disc degeneration ,no collapse,no abscess &
no neurological deficits.
• The treatment is fine needle biopsy & drug
therapy .

22. Treatment continued
• Type 1 B
• Abscess formation ,one or two level disc
degeneration but no collapse & no
neurological deficits.
• The treatment is abscess drainage &
debridement.

23. Treatment continued
• Type 2
• Abscess formation, vertebral
collapse,kyphosis,stable deformity with or
without neurological deficit.
• The treatment is ;
• Anterior debridement & fusion
• Decompression
• Bone grafting

24. Treatment continued
• Type 3
• Severe vertebral collapse,abscess
formation,severe kyphosis & instable
deformity with or without neurological deficit.
• The treatment is;
• Anterior debridement & fusion
• Decompression
• Correction of deformity & internal fixation

25. Surgical treatment

26. Summary
• Imaging modalities are plain film, CT and MRI;
MRI is gold standard for imaging spinal
• Diagnosis and treatment of spinal TB in endemic
areas is difficult given resource limitations; rely
on radiographs and clinical signs to facilitate
early diagnosis.
• Conservative versus surgical treatment of Pott
disease depends on degree of spinal destruction,
making early diagnosis essential for a positive
outcome.

27. THANK YOU