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Tuberculosis of the Spine
Tuberculosis of the spine, also known as Pott's disease after the man who first described the condition, Sir Percival Potts, in 1779, is the most common form of musculoskeletal tuberculosis accounting for approximately half of skeletal cases. It is considered to be one of the oldest documented infections, with evidence from human remains from Iron Age Europe and Ancient Egypt. It is considered to have greater affect in children and young adults and predominantly affects the thoracic and lumbar regions of the spine, although evidence of cervical involvement is also available.
Involvement of the spine is usually severe and typically involves numerous vertebrae. It is a secondary infection caused by haematogenous or lymphatic spread of infection from a primary source. Infection usually begins in the anterior part of the vertebral body and spreads to incorporate adjoining disc space which leads to a narrowing of joint space, noticeable in radiological examination. Development of the infection leads to vertebral collapse resulting in anterior wedging, producing the characteristic angular deformity associated with spinal TB know as a kyphosis or gibbus deformity.
Paravertebral abscesses may also form when diseased tissue in the vicinity of the affected vertebrae forms a mass where pus can collect. A combination of abscess formation and vertebral collapse can lead to compression of the spinal cord and as such individuals with Pott's disease can experience paraplegia and potential loss of urinary control. Neurological problems are also possible, particularly when the infection affects the upper and mid thoracic vertebrae.
Spinal tuberculosis generally presents with standard tuberculous symptoms including fever, night sweats, weight loss and loss of appetite or anorexia. In addition there is usually pain and swelling in the soft tissue surrounding the affected vertebrae and the possibility of cutaneous sinus formation. Tuberculosis in the cervical vertebrae may also present with neck stiffness, dysphagia - the inability to swallow, and stridor - a harsh vibrating noise when breathing caused by a blockage in the windpipe or larynx.
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