Introduction

Tuberculosis (TB) of the spine (Pott’s disease) is the most common site of bone infection in TB; hips and knees are also often affected.  The lower thoracic and upper lumbar vertebrae are the areas of the spine most often affected. 

Pathogenesis of Pott’s disease

Diagnosis of Pott’s disease

Clinical

The disease progresses slowly.  Signs and symptoms include:

• Localised back pain
• Paravertebral swelling may be seen
• Systemic signs and symptoms of TB may be present
• Neurological signs may occur, leading to paraplegia.

Microbiology

• Needle biopsy of bone or synovial tissue. Numbers of tubercle bacilli present are usually low but are pathognomonic. 
• Acid-fast stain and culture for Mycobacterium tuberculosis, plus fungi and other pathogens, should be performed.

Imaging

• Spinal x-ray may not show early disease as 50% of bone mass must be lost for changes to be visible on x-ray. However, plain radiographs can show vertebral destruction and narrowed disc space.
• MRI is useful to demonstrate the extent of spinal compression and can show changes at an earlier stage than plain radiographs. Bone elements visible within the swelling, or abscesses, are strongly indicative of Pott’s disease as opposed to malignancy. 
• CT scans and nuclear bone scans can also be used.

Management of Pott’s disease

Drug treatment is generally sufficient for Pott’s disease, with spinal immobilisation if required.  Surgery is required if there is spinal deformity or neurological signs of spinal cord compression.

Standard antituberculosis treatment is required.

Duration of antituberculosis treatment:

• If debridement and fusion with bone grafting are performed, treatment can be for six months
• If debridement and fusion with bone grafting are NOT performed a minimum of 12 months’ treatment is required.