Pott’s disease

Overview of Pott’s disease

Lung diseases and their complications are quite severe. Most of the associated complications are pertaining to respiratory ailments. Hence many are not aware that lung diseases may even give rise to musculoskeletal disorders. Pott’s disease is one such disease where spine disorders arise from certain lung ailments. The complications are very serious since the patient shows symptoms of both pulmonary diseases and joint problems.

What is Pott’s disease?

Pott’s disease is a type of tuberculosis which mainly manifests itself through certain complications in the vertebral bones. Although it is primarily a lung disease, some of the tissues present outside the lungs are also affected. In the advanced stages, the disease even progresses to the spine and affects the intervertebral joints. Mainly considering the different symptoms, Pott’s disease is also known as “tuberculosis spondylitis” or “spinal tuberculosis”. It was named after the British surgeon, Percivall Pott who discovered and explained the symptoms first. The symptoms are mostly restricted to the thoracic portion of the spine and affect mainly the upper lumbar vertebrae and the lower thoracic vertebrae. As the disease progresses, the symptoms are felt in the adjoining areas as well.

What causes Pott’s disease?

Pott’s disease starts with Tuberculosis, which is a lung infection caused by Mycobacterium tuberculosis. A slow and hematogenous spread of tuberculosis to the neighboring sites, particularly the spine, leads to Pott’s disease. The severity increases when the infections spread from the adjacent vertebra into the intervertebral disc space. The disc remains in normal condition when only one vertebra is affected. But when two successive vertebral bones are affected, the disc (which is devoid of blood vessels) stops receiving nutrients through blood and collapses completely. A phenomenon known as caseous necrosis is observed in these cases, wherein the disc tissue dies. This leads to three phenomena-

• Vertebral narrowing
• Vertebral collapse
• Spinal damage

A dry mass of soft tissue is formed, reducing the chances of associated infections.

The best way to prevent Pott’s disease is to find an effective remedy for TB. Try these top-rated natural products to fight a TB infection.

What are the main warning signs and symptoms?

Pott’s disease is characterized by both pulmonary and skeletal symptoms. These will be discussed in separate sections.

Pulmonary symptoms

The patient mainly shows some prominent respiratory symptoms which are as follows-

• A persistent cough (productive or non-productive)
• Frequent sneezing
• Difficulty breathing (due to partial obstruction of the respiratory tract)
• Pain in the chest during breathing, coughing and sneezing
• Feeling of tightness around the chest
• High fever and headache
• Body pain and occasional chills
• Production of blood-tinged sputum
• Pain in the diaphragm region radiating to the abdomen
• Increased heart rate
• Gastrointestinal disorders
• Generation of wheezing sound during breathing
• Loss of appetite
• Weight loss
• Dizziness and fatigue
• Disturbed sleep
• Disturbed mental state

Joint problems

Along with the pulmonary symptoms, the patient experiences some major joint problems in the spine which are listed below-

• Stiffness and pain in the joint especially in the morning
• Pain and stiffness in the neck, back and buttocks
• Pain and inflammation in the tendons and the ligaments, which is felt mainly in the chest, back of the heel or underneath the foot
• Inflammation and swelling of the joints and the soft tissues
• Joint pain during slight movements
• Temporary immobility (permanent immobility may also occur due to ankylosed or fused joints)
• Cracking and crunching sounds during normal joint movements
• Weakness and fatigue of muscles (may lead to muscular dystrophy)
• Pain radiating to neighbouring regions (lower extremities)
• Redness around the joint area
• Extreme tenderness and touch sensitivity of joints
• Throbbing pain in the joint and muscles after some activity
• Bone and joint deformities (at an advanced stage)
• Disturbed sleep due to increased joint pain at night
• Difficulty maintaining normal body postures
• Difficulty performing mundane activities such as walking, running, climbing stairs
• Body aches and fever
• Extreme fatigue
• Loss of appetite
• Visible bulges (due to bone spurs)

How is Pott’s disease diagnosed and treated?

For the proper detection of Pott’s disease, a detailed diagnosis of both the respiratory manifestations and the joint ailments is very necessary. For the detection of Tuberculosis, the following diagnostic tests are preferable-

• Chest X-ray (to examine the condition of the lungs)
• Sputum cultures (to look for the presence of bacteria)
• Blood culture
• Tissue biopsy (to check for the possibilities of cancer)
• Mantoux Tuberculin skin tests ( results are positive in 84-95% of the patients having Pott’s disease)
• Nucleic acid amplification test

In addition to the above tests, the doctors also advise the patients to get the following laboratory examinations done in order to detect the extent of the joint problems-

• Blood tests: The patients generally show an elevated level of C-reactive protein (CRP) and ESR. This is not necessarily related to the degree of inflammation since people having very serious inflammation often have normal or close to normal values of CRP and ESR. An ESR greater than 100 mm/h indicates Pott’s disease. Complete blood count (CBC) is often carried out in order to detect if leukocytosis has occurred or not.
• Genetic tests: These are required to test for HLA-B27. Above 90% of the patients diagnosed with AS have been tested positive for HLA-B27.
• BASDAI: The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) gives a measure of the inflammatory burden of the existing diseases.
• Schober’s test: It measures the flexion of the lumbar spine during the preliminary physical examination.

The radiographs of the spine yield the following results-

• Collapse of the vertebral body
• Osteoporosis of the vertebral endplates
• Destruction of the intervertebral discs
• Fusiform paravertebral shadows (indicates abscess formation)
• Bone lesions

The first line of treatment for Pott’s disease is the surgical debridement of the entire focus of the tubercular infection. Administration of anti-tubercular medications is done before and after the surgery. This procedure is followed by the surgical reconstruction of the spine.

The treatment protocol is formulated based on the presence or absence of neurological involvement. In case of neurological involvement usually, pharmacotherapy is preferred over surgery. The anti-tubercular medications employed in the pharmacotherapy are Isoniazid, Rifampicin, Ethambutol, and Pyrazinamide.

Is it preventable?

If you have been diagnosed with tuberculosis, it is highly important for you to undergo extensive treatment to completely cure this condition.  When tuberculosis is not treated appropriately or if there is any delay in the treatment, it can result in spreading of the disease to the surrounding tissues.  In some cases, it can affect the spinal cord as well as the vertebral joints.

If you are facing problems with vitamin D, there is a possibility that your musculoskeletal system is not strong enough to withstand the infection and can lead to the breaking of the bone easily.  It is recommended to have adequate vitamin D levels so that calcium is absorbed from the food we eat and provide a healthy musculoskeletal system.

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