Pott's disease natural history, complications and prognosis: Difference between revisions
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{{Pott's disease}} | {{Pott's disease}} | ||
{{CMG}}; {{AE}} {{HP}} | {{CMG}}; {{AE}} {{HP}} | ||
==Overview== | ==Overview== | ||
[[Pott's disease]] may be complicated by severe vertebral deformity and collapse resulting in [[kyphosis]], [[cord compression]], and [[paraplegia]]. It responds well to treatment with improvement of the neurological function and spinal deformity. | [[Pott's disease]] may be complicated by severe vertebral deformity and collapse resulting in [[kyphosis]], [[cord compression]], and [[paraplegia]]. It responds well to treatment with improvement of the neurological function and spinal deformity. | ||
==Natural History== | ==Natural History== | ||
[[Pott's disease|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]].<ref name="pmid27435619">{{cite journal| author=Kumar K| title=Spinal tuberculosis, natural history of disease, classifications and principles of management with historical perspective. | journal=Eur J Orthop Surg Traumatol | year= 2016 | volume= 26 | issue= 6 | pages= 551-8 | pmid=27435619 | doi=10.1007/s00590-016-1811-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27435619 }} </ref><ref name="pmid26260836">{{cite journal| author=Ratnappuli A, Collinson S, Gaspar-García E, Richardson L, Bernard J, Macallan D| title=Pott's disease in twenty-first century London: spinal tuberculosis as a continuing cause of morbidity and mortality. | journal=Int J Tuberc Lung Dis | year= 2015 | volume= 19 | issue= 9 | pages= 1125, i-ii | pmid=26260836 | doi=10.5588/ijtld.15.0091 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26260836 }} </ref> | [[Pott's disease|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]].<ref name="pmid27435619">{{cite journal| author=Kumar K| title=Spinal tuberculosis, natural history of disease, classifications and principles of management with historical perspective. | journal=Eur J Orthop Surg Traumatol | year= 2016 | volume= 26 | issue= 6 | pages= 551-8 | pmid=27435619 | doi=10.1007/s00590-016-1811-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27435619 }} </ref><ref name="pmid26260836">{{cite journal| author=Ratnappuli A, Collinson S, Gaspar-García E, Richardson L, Bernard J, Macallan D| title=Pott's disease in twenty-first century London: spinal tuberculosis as a continuing cause of morbidity and mortality. | journal=Int J Tuberc Lung Dis | year= 2015 | volume= 19 | issue= 9 | pages= 1125, i-ii | pmid=26260836 | doi=10.5588/ijtld.15.0091 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26260836 }} </ref> | ||
==Complications== | ==Complications== | ||
The [[destruction]] of the [[intervertebral disc]], body of the [[vertebra]] and spread of the [[infection]] can result the following [[complications]]:<ref name="pmid27435619">{{cite journal| author=Kumar K| title=Spinal tuberculosis, natural history of disease, classifications and principles of management with historical perspective. | journal=Eur J Orthop Surg Traumatol | year= 2016 | volume= 26 | issue= 6 | pages= 551-8 | pmid=27435619 | doi=10.1007/s00590-016-1811-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27435619 }} </ref><ref name="pmid26745350">{{cite journal| author=Liu C, Lin L, Wang W, Lv G, Deng Y| title=Long-term outcomes of vertebral column resection for kyphosis in patients with cured spinal tuberculosis: average 8-year follow-up. | journal=J Neurosurg Spine | year= 2016 | volume= 24 | issue= 5 | pages= 777-85 | pmid=26745350 | doi=10.3171/2015.8.SPINE15534 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26745350 }} </ref><ref name="pmid26232534">{{cite journal| author=Batirel A, Erdem H, Sengoz G, Pehlivanoglu F, Ramosaco E, Gülsün S et al.| title=The course of spinal tuberculosis (Pott disease): results of the multinational, multicentre Backbone-2 study. | journal=Clin Microbiol Infect | year= 2015 | volume= 21 | issue= 11 | pages= 1008.e9-1008.e18 | pmid=26232534 | doi=10.1016/j.cmi.2015.07.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26232534 }} </ref> | The [[destruction]] of the [[intervertebral disc]], body of the [[vertebra]] and spread of the [[infection]] can result the following [[complications]]:<ref name="pmid27435619">{{cite journal| author=Kumar K| title=Spinal tuberculosis, natural history of disease, classifications and principles of management with historical perspective. | journal=Eur J Orthop Surg Traumatol | year= 2016 | volume= 26 | issue= 6 | pages= 551-8 | pmid=27435619 | doi=10.1007/s00590-016-1811-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27435619 }} </ref><ref name="pmid26745350">{{cite journal| author=Liu C, Lin L, Wang W, Lv G, Deng Y| title=Long-term outcomes of vertebral column resection for kyphosis in patients with cured spinal tuberculosis: average 8-year follow-up. | journal=J Neurosurg Spine | year= 2016 | volume= 24 | issue= 5 | pages= 777-85 | pmid=26745350 | doi=10.3171/2015.8.SPINE15534 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26745350 }} </ref><ref name="pmid26232534">{{cite journal| author=Batirel A, Erdem H, Sengoz G, Pehlivanoglu F, Ramosaco E, Gülsün S et al.| title=The course of spinal tuberculosis (Pott disease): results of the multinational, multicentre Backbone-2 study. | journal=Clin Microbiol Infect | year= 2015 | volume= 21 | issue= 11 | pages= 1008.e9-1008.e18 | pmid=26232534 | doi=10.1016/j.cmi.2015.07.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26232534 }} </ref> | ||
| Line 20: | Line 15: | ||
* The [[infection]] can spread to the [[mediastinum]] or [[trachea]] when the [[abscess]] develops in the [[thoracic spine]]. | * 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 (anatomy)|sinus]] . | * [[Infection]] can spread down the [[sheath]] of the [[psoas muscle]] to the [[femoral trigone]] to form a [[Sinus (anatomy)|sinus]] . | ||
==Prognosis== | ==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]].<ref name="pmid27366249">{{cite journal| author=Patankar AP| title=Tuberculosis of spine: An experience of 30 cases over two years. | journal=Asian J Neurosurg | year= 2016 | volume= 11 | issue= 3 | pages= 226-31 | pmid=27366249 | doi=10.4103/1793-5482.145085 | pmc=4849291 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27366249 }} </ref> | [[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]].<ref name="pmid27366249">{{cite journal| author=Patankar AP| title=Tuberculosis of spine: An experience of 30 cases over two years. | journal=Asian J Neurosurg | year= 2016 | volume= 11 | issue= 3 | pages= 226-31 | pmid=27366249 | doi=10.4103/1793-5482.145085 | pmc=4849291 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27366249 }} </ref> | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hardik Patel, M.D.
Overview
Pott's disease may be complicated by severe vertebral deformity and collapse resulting in kyphosis, cord compression, and paraplegia. It responds well to treatment with improvement of the neurological function and spinal deformity.
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.[1][2]
Complications
The destruction of the intervertebral disc, body of the vertebra and spread of the infection can result the following complications:[1][3][4]
- Vertebral collapse resulting in kyphosis
- Spinal cord compression
- Paraplegia (so called Pott's paraplegia) or tetraplegia can result from spinal cord compression.
- Formation of a cold abscess when the infection spreads to the adjacent ligaments. [5]
- 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.[6]
References
- ↑ 1.0 1.1 Kumar K (2016). "Spinal tuberculosis, natural history of disease, classifications and principles of management with historical perspective". Eur J Orthop Surg Traumatol. 26 (6): 551–8. doi:10.1007/s00590-016-1811-x. PMID 27435619.
- ↑ Ratnappuli A, Collinson S, Gaspar-García E, Richardson L, Bernard J, Macallan D (2015). "Pott's disease in twenty-first century London: spinal tuberculosis as a continuing cause of morbidity and mortality". Int J Tuberc Lung Dis. 19 (9): 1125, i–ii. doi:10.5588/ijtld.15.0091. PMID 26260836.
- ↑ Liu C, Lin L, Wang W, Lv G, Deng Y (2016). "Long-term outcomes of vertebral column resection for kyphosis in patients with cured spinal tuberculosis: average 8-year follow-up". J Neurosurg Spine. 24 (5): 777–85. doi:10.3171/2015.8.SPINE15534. PMID 26745350.
- ↑ Batirel A, Erdem H, Sengoz G, Pehlivanoglu F, Ramosaco E, Gülsün S; et al. (2015). "The course of spinal tuberculosis (Pott disease): results of the multinational, multicentre Backbone-2 study". Clin Microbiol Infect. 21 (11): 1008.e9–1008.e18. doi:10.1016/j.cmi.2015.07.013. PMID 26232534.
- ↑ de Araújo GC, Ferreira Junior Dde S, Escarso Junior Lda R, Gameiro VS (2014). "Spinal tuberculosis presenting with hip abscesses: a diagnostic challenge". BMJ Case Rep. 2014. doi:10.1136/bcr-2014-205569. PMC 4173196. PMID 25253485.
- ↑ Patankar AP (2016). "Tuberculosis of spine: An experience of 30 cases over two years". Asian J Neurosurg. 11 (3): 226–31. doi:10.4103/1793-5482.145085. PMC 4849291. PMID 27366249.