Pott's disease pathophysiology
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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 occurs usually due to hematogenous spread of tuberculous infection from an extraspinal source. Pott's disease usually involves more than one vertebra and manifests as a combination of osteomyelitis and arthritis.
Pathophysiology
- Skeletal involvement occurs approximately in 10% of patients with extrapulmonary tuberculosis.[1]
- Spinal tuberculosis is the most commonly affected site in skeletal tuberculosis and accounts for 50% of cases with skeletal tuberculosis.[1]
Pott's disease occurs usually due to hematogenous spread of infection from an extraspinal source. Pott's disease usually involves more than one vertebra and manifests as a combination of osteomyelitis and arthritis. First anterior aspect of the vertebral body adjacent to the subchondral plate is affected. Then tuberculosis may spread into adjacent intervertebral disks. Intervertebral disk disease occurs due to spread of infection from the vertebral body in adults, whereas the disk can be the primary site of infection in children because it is vascularized. This is followed by progressive bone destruction, which leads to vertebral collapse and kyphosis. Tuberculous abscesses, granulomas, and direct invasion of dura may cause narrowing of spinal canal, which leads to cord compression and neurologic deficits. Kyphosis occurs more likely due to lesions in the thoracic spine than the lumbar spine. Collapse in the anterior spine is responsible for kyphosis. If the infection extends to adjacent ligaments and soft tissues, cold abscess may develop. In the lumbar region, abscesses may descend down the sheath of the psoas muscle to the femoral trigone and eventually invade the skin.
Genetics
- A study of 109 patients in the china with spinal TB, showed a higher frequencies FokI polymorphism in the vitamin-D receptor gene in patients with tuberculosis.[2]
References
- ↑ 1.0 1.1 Gautam MP, Karki P, Rijal S, Singh R (2005). "Pott's spine and paraplegia". JNMA J Nepal Med Assoc. 44 (159): 106–15. PMID 16570378.
- ↑ Zhang HQ, Deng A, Guo CF, Wang YX, Chen LQ, Wang YF; et al. (2010). "Association between FokI polymorphism in vitamin D receptor gene and susceptibility to spinal tuberculosis in Chinese Han population". Arch Med Res. 41 (1): 46–9. doi:10.1016/j.arcmed.2009.12.004. PMID 20430254.