Pott's disease is a presentation of extrapulmonary tuberculosis

Tuberculosis

Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...

 that affects the spine

Vertebral column

In human anatomy, the vertebral column is a column usually consisting of 24 articulating vertebrae, and 9 fused vertebrae in the sacrum and the coccyx. It is situated in the dorsal aspect of the torso, separated by intervertebral discs...

, a kind of tuberculous arthritis of the intervertebral joints. It is named after Percivall Pott

Percivall Pott

Sir Percivall Pott London, England) was an English surgeon, one of the founders of orthopedy, and the first scientist to demonstrate that a cancer may be caused by an environmental carcinogen.-Life:...

 (1714–1788), a London surgeon who trained at St Bartholomew's Hospital

St Bartholomew's Hospital

St Bartholomew's Hospital, also known as Barts, is a hospital in Smithfield in the City of London, England.-Early history:It was founded in 1123 by Raherus or Rahere , a favourite courtier of King Henry I...

, London.
The lower thoracic

Thoracic vertebrae

In human anatomy, twelve thoracic vertebrae compose the middle segment of the vertebral column, between the cervical vertebrae and the lumbar vertebrae. They are intermediate in size between those of the cervical and lumbar regions; they increase in size as one proceeds down the spine, the upper...

 and upper lumbar vertebrae

Lumbar vertebrae

The lumbar vertebrae are the largest segments of the movable part of the vertebral column, and are characterized by the absence of the foramen transversarium within the transverse process, and by the absence of facets on the sides of the body...

 are the areas of the spine most often affected.
Scientifically, it is called tuberculous spondylitis

Spondylitis

Spondylitis is an inflammation of the vertebra. It is a form of spondylopathy. In many cases, spondylitis involves one or more vertebral joint as well, which itself is called spondylarthritis.-Examples:...

 and it is most commonly localized in the thoracic portion of the spine.
Pott’s disease results from haematogenous spread of tuberculosis from other sites, often pulmonary. The infection then spreads from two adjacent vertebrae into the adjoining intervertebral disc

Intervertebral disc

Intervertebral discs lie between adjacent vertebrae in the spine. Each disc forms a cartilaginous joint to allow slight movement of the vertebrae, and acts as a ligament to hold the vertebrae together.-Structure:...

 space. If only one vertebra is affected, the disc is normal, but if two are involved, the disc, which is avascular, cannot receive nutrients and collapses. The disc tissue dies and is broken down by caseation, leading to vertebral narrowing and eventually to vertebral collapse and spinal damage. A dry soft tissue mass often forms and superinfection is rare.

Signs and symptoms

• back pain
  Back pain
  Back pain is pain felt in the back that usually originates from the muscles, nerves, bones, joints or other structures in the spine.The pain can often be divided into neck pain, upper back pain, lower back pain or tailbone pain...
  
  
• fever
  Fever
  Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
  
  
• night sweating
  Sweating
  Perspiration is the production of a fluid consisting primarily of water as well as various dissolved solids , that is excreted by the sweat glands in the skin of mammals...
  
  
• anorexia
  Anorexia (symptom)
  Anorexia is the decreased sensation of appetite...
  
  
• weight loss
  Weight loss
  Weight loss, in the context of medicine, health or physical fitness, is a reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue...
  
  
• Spinal mass, sometimes associated with numbness, paraesthesia, or muscle weakness
  Muscle weakness
  Muscle weakness or myasthenia is a lack of muscle strength. The causes are many and can be divided into conditions that have true or perceived muscle weakness...
  
   of the legs

Diagnosis

• blood test
  Blood test
  A blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a needle, or via fingerprick....
  
  s – elevated erythrocyte sedimentation rate
  Erythrocyte sedimentation rate
  The erythrocyte sedimentation rate , also called a sedimentation rate or Biernacki Reaction, is the rate at which red blood cells sediment in a period of 1 hour...
  
  
• tuberculin skin test
• radiographs of the spine
• bone scan
  Bone scan
  A bone scan or bone scintigraphy is a nuclear scanning test to find certain abnormalities in bone which are triggering the bone's attempts to heal. It is primarily used to help diagnose a number of conditions relating to bones, including: cancer of the bone or cancers that have spread to the bone,...
  
  
• CT
  Computed tomography
  X-ray computed tomography or Computer tomography , is a medical imaging method employing tomography created by computer processing...
  
   of the spine
• bone biopsy
  Biopsy
  A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
  
  
• MRI

Late complications

• Vertebral collapse resulting in kyphosis
  Kyphosis
  Kyphosis , also called roundback or Kelso's hunchback, is a condition of over-curvature of the thoracic vertebrae...
  
  
• Spinal cord compression
  Spinal cord compression
  Spinal cord compression develops when the spinal cord is compressed by bone fragments from a vertebral fracture, a tumor, abscess, ruptured intervertebral disc or other lesion...
  
  
• sinus
  Sinus (anatomy)
  Sinus is Latin for "bay", "pocket", "curve", or "bosom". In anatomy, the term is used in various contexts.A sinus is a sack or cavity in any organ or tissue, or an abnormal cavity or passage caused by the destruction of tissue...
  
   formation
• paraplegia
  Paraplegia
  Paraplegia is an impairment in motor or sensory function of the lower extremities. The word comes from Ionic Greek: παραπληγίη "half-striking". It is usually the result of spinal cord injury or a congenital condition such as spina bifida that affects the neural elements of the spinal canal...
  
   (so called Pott's paraplegia)

Prevention

Controlling the spread of tuberculosis infection can prevent tuberculous spondylitis and arthritis. Patients who have a positive PPD test

Mantoux test

The Mantoux test is a diagnostic tool for tuberculosis. It is one of the two major tuberculin skin tests used in the world, largely replacing multiple-puncture tests such as the Tine test...

 (but not active tuberculosis) may decrease their risk by properly taking medicines to prevent tuberculosis. To effectively treat tuberculosis, it is crucial that patients take their medications exactly as prescribed.

Therapy

• non-operative – antituberculous drugs
  Tuberculosis treatment
  Tuberculosis treatment refers to the medical treatment of the infectious disease tuberculosis .The standard "short" course treatment for TB is isoniazid, rifampicin , pyrazinamide, and ethambutol for two months, then isoniazid and rifampicin alone for a further four months...
  
  
• Chiropractic treatments
• analgesic
  Analgesic
  An analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....
  
  s
• immobilization of the spine region by rod (Hull)
• Surgery
  Surgery
  Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
  
   may be necessary, especially to drain spinal abscess
  Abscess
  An abscess is a collection of pus that has accumulated in a cavity formed by the tissue in which the pus resides due to an infectious process or other foreign materials...
  
  es or to stabilize the spine
• Richards intramedullary hip screw – facilitating for bone healing
• Kuntcher Nail – intramedullary rod
  Intramedullary rod
  An intramedullary rod, also known as an intramedullary nail or inter-locking nail or Küntscher nail, is a metal rod forced into the medullary cavity of a bone. IM nails have long been used to treat fractures of long bones of the body. Gerhard Küntscher is credited with the first use of this device...
  
  
• Austin Moore – intrameduallary rod (for Hemiarthroplasty)
• Thoracic spinal fusion as a last resort

Cultural references

The fictional Hunchback of Notre Dame had a gibbous deformity (humpback) that is thought to have been caused by tuberculosis. In Henrik Ibsen

Henrik Ibsen

Henrik Ibsen was a major 19th-century Norwegian playwright, theatre director, and poet. He is often referred to as "the father of prose drama" and is one of the founders of Modernism in the theatre...

's play "A Doll's House," Dr. Rank suffers from "consumption of the spine." Furthermore, Jocelin, the Dean who wanted a spire on his cathedral in William Golding

William Golding

Sir William Gerald Golding was a British novelist, poet, playwright and Nobel Prize for Literature laureate, best known for his novel Lord of the Flies...

's "The Spire" probably suffered and died as a result of this disease. English poets Alexander Pope

Alexander Pope

Alexander Pope was an 18th-century English poet, best known for his satirical verse and for his translation of Homer. He is the third-most frequently quoted writer in The Oxford Dictionary of Quotations, after Shakespeare and Tennyson...

 and William Ernest Henley

William Ernest Henley

William Ernest Henley was an English poet, critic and editor, best remembered for his 1875 poem "Invictus".-Life and career:...

 both suffered from Pott's disease. Anna Roosevelt Cowles, sister of president Theodore Roosevelt

Theodore Roosevelt

Theodore "Teddy" Roosevelt was the 26th President of the United States . He is noted for his exuberant personality, range of interests and achievements, and his leadership of the Progressive Movement, as well as his "cowboy" persona and robust masculinity...

, suffered from Pott's Disease. Chick Webb

Chick Webb

William Henry Webb, usually known as Chick Webb was an American jazz and swing music drummer as well as a band leader.-Biography:...

, swing era drummer and band leader, was afflicted with tuberculosis of the spine as a child, which left him hunchbacked. The Sicilian

Sicily

Sicily is a region of Italy, and is the largest island in the Mediterranean Sea. Along with the surrounding minor islands, it constitutes an autonomous region of Italy, the Regione Autonoma Siciliana Sicily has a rich and unique culture, especially with regard to the arts, music, literature,...

 mafia

Mafia

The Mafia is a criminal syndicate that emerged in the mid-nineteenth century in Sicily, Italy. It is a loose association of criminal groups that share a common organizational structure and code of conduct, and whose common enterprise is protection racketeering...

 boss Luciano Leggio

Luciano Leggio

Luciano Leggio was an Italian criminal and leading figure of the Sicilian Mafia. He was the head of the Corleonesi, the Mafia faction that originated in the town of Corleone...

 had Pott's disease and wore a brace. Morton, the railroad magnate in Once Upon a Time in the West

Once Upon a Time in the West

Once Upon a Time in the West is a 1968 Italian epic spaghetti western film directed by Sergio Leone for Paramount Pictures. It stars Henry Fonda cast against type as the villain, Charles Bronson as his nemesis, Jason Robards as a bandit, and Claudia Cardinale as a newly widowed homesteader with a...

, suffers from the disease and needs crutches to walk. Writer Max Blecher also had Pott's Disease. Marxist thinker and Communist leader Antonio Gramsci

Antonio Gramsci

Antonio Gramsci was an Italian writer, politician, political philosopher, and linguist. He was a founding member and onetime leader of the Communist Party of Italy and was imprisoned by Benito Mussolini's Fascist regime...

 suffered from Pott's disease, probably due to the bad conditions of his incarceration in fascist Italy

Fascist Italy

"Fascist Italy" refers to Italy under the rule of Benito Mussolini and Italian Fascism. The Fascists led two polities:*The Kingdom of Italy , under the National Fascist Party, and,...

 during the 1930s. Italian writer, poet and phylosopher Giacomo Leopardi

Giacomo Leopardi

Giacomo Taldegardo Francesco di Sales Saverio Pietro Leopardi was an Italian poet, essayist, philosopher, and philologist...

suffered too of this desease.