Pott's disease natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hardik Patel, M.D.

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Overview

Pott's disease may be complicated by severe vertebral deformity and collapse resulting in kyphosis, cord compression, sinus formation, and paraplegia. However, it responds well to treatment, if it is not complicated by severe deformity or established neurologic deficit.

Natural History

Spinal tuberculosis is one of the common extra-pulmonary manifestation involving the skeletal system. The common affected sites include the upper lumbar and lower thoracic spine. The infection affects the body of the vertebra or the the intervertebral discs. The progression of the disease is slow with a wide variation in the time of infection to manifestations of disease . The average disease duration ranges from 4 to 11 months. Patients take medical help when they develop severe pain, marked deformity or neurological symptoms.

Complications

The destruction of the intervertebral disc, body of the vertebra and spread of the infection can result the following complications:

• Vertebral collapse resulting in kyphosis
• Spinal cord compression
• Paraplegia (so called Pott's paraplegia) or tetraplegia can result from cord compression. The rate of neurological symptoms ranges from 23 to 76% patients.
• Formation of a cold abscess when the infection spreads to the adjacent ligaments.
• Cold abscess in the cervical spine, can cause the spread of infection to form a retropharyngeal abscess.
• The infection can spread to the mediastinum or trachea when the abscess develops in the thoracic spine.
• Infection can spread down the sheath of the psoas muscle to the femoral trigone to form a sinus .

Prognosis

Pott's disease responds well to treatment with antitubercular treatment. Improvement in pain and neurological deficits are indicators for response to treatment. Prognosis is good in all patients, if a lack of improvement persists other differential must be considered before surgery.