eMedicine Specialties > Infectious Diseases > Bone and Joint Infections

Pott Disease (Tuberculous Spondylitis): Follow-up

Author: Jose A Hidalgo, MD, Assistant Professor, Universidad de San Marcos Medical School; Attending Physician, Department of Internal Medicine, Division of Infectious Diseases, Guillermo Almenara Hospital
Coauthor(s): George Alangaden, MD, Staff Physician, Associate Professor, Department of Internal Medicine, Division of Infectious Diseases, Detroit Medical Center, Wayne State University School of Medicine
Contributor Information and Disclosures

Updated: Aug 29, 2008

Follow-up

Further Inpatient Care

  • Once the diagnosis of Pott disease is established and treatment is started, the duration of hospitalization depends on the need for surgery and the clinical stability of the patient.

Further Outpatient Care

  • Patients with Pott disease should be closely monitored to assess their response to therapy and compliance with medication. Directly observed therapy may be required.
  • The development or progression of neurologic deficits, spinal deformity, or intractable pain should be considered evidence of poor therapeutic response. This raises the possibility of antimicrobial drug resistance as well as the necessity for surgery.
  • Because of the risk of deformity exacerbations, children with Pott disease should undergo long-term follow-up until their entire growth potential is completed.25

Complications

  • Abscess
  • Spine deformities
  • Neurologic deficits and paraplegia

Prognosis

  • Current treatment modalities are highly effective if not complicated by severe deformity or established neurologic deficit.
  • Therapy compliance and drug resistance are additional factors that significantly affect individual outcomes.
  • Paraplegia resulting from the active disease causing cord compression usually responds well to chemotherapy.
  • If medical therapy does not result in rapid improvement, operative decompression will greatly increase the recovery rate.
  • Paraplegia can manifest or persist during healing because of permanent spinal cord damage.

Patient Education

  • Patients with Pott disease should be instructed on the importance of therapy compliance.
  • For excellent patient education resources, visit eMedicine's Bacterial and Viral Infections Center. Also, see eMedicine's patient education article Tuberculosis.

Miscellaneous

Medicolegal Pitfalls

  • A large proportion of patients with Pott disease do not present with extraskeletal disease. In reported series, only 10-38% of cases of Pott disease are associated with extraskeletal tuberculosis.
  • The diagnosis of tuberculous spondylitis should be investigated if strong clinical suspicion exists, even if suggestive pulmonary radiology findings are absent.
  • Other features suggestive of tuberculosis include the following:
    • Positive PPD result
    • Chest radiograph that shows apical scarring, infiltrates, or cavitary disease
    • Presence of risk factors for tuberculosis
  • Spinal tuberculosis should always be suspected when radiographs demonstrate a destructive spine process.
 


More on Pott Disease (Tuberculous Spondylitis)

Overview: Pott Disease (Tuberculous Spondylitis)
Differential Diagnoses & Workup: Pott Disease (Tuberculous Spondylitis)
Treatment & Medication: Pott Disease (Tuberculous Spondylitis)
Follow-up: Pott Disease (Tuberculous Spondylitis)
Multimedia: Pott Disease (Tuberculous Spondylitis)
References
[ CLOSE WINDOW ]

References

  1. Taylor GM, Murphy E, Hopkins R, et al. First report of Mycobacterium bovis DNA in human remains from the Iron Age. Microbiology. Apr 2007;153:1243-9. [Medline].

  2. Pott P. The chirurgical works of Percivall Pott, F.R.S., surgeon to St. Bartholomew's Hospital, a new edition, with his last corrections. 1808. Clin Orthop Relat Res. May 2002;4-10. [Medline].

  3. Davidson PT, Le HQ. Tuberculosis and Nontuberculous Mycobacterial Infections. In: Schlossberg D, ed. Musculoskeletal Tuberculosis. 4th ed. Saint Louis, MO: W B Saunders; 1999:204-20.

  4. Leibert E, Haralambou G. Tuberculosis. In: Rom WN and Garay S, eds. Spinal tuberculosis. Lippincott, Williams and Wilkins; 2004:565-77.

  5. te Beek LA, van der Werf MJ, Richter C, et al. Extrapulmonary tuberculosis by nationality, The Netherlands, 1993-2001. Emerg Infect Dis. Sep 2006;12(9):1375-82. [Medline].

  6. Lifeso RM, Weaver P, Harder EH. Tuberculous spondylitis in adults. J Bone Joint Surg Am. Dec 1985;67(9):1405-13. [Medline].

  7. Pertuiset E, Beaudreuil J, Liote F, et al. Spinal tuberculosis in adults. A study of 103 cases in a developed country, 1980-1994. Medicine (Baltimore). Sep 1999;78(5):309-20. [Medline].

  8. Turgut M. Spinal tuberculosis (Pott's disease): its clinical presentation, surgical management, and outcome. A survey study on 694 patients. Neurosurg Rev. Mar 2001;24(1):8-13. [Medline].

  9. Le Page L, Feydy A, Rillardon L, et al. Spinal tuberculosis: a longitudinal study with clinical, laboratory, and imaging outcomes. Semin Arthritis Rheum. Oct 2006;36(2):124-9. [Medline].

  10. Park DW, Sohn JW, Kim EH, et al. Outcome and management of spinal tuberculosis according to the severity of disease: a retrospective study of 137 adult patients at Korean teaching hospitals. Spine. Feb 15 2007;32(4):E130-5. [Medline].

  11. Cormican L, Hammal R, Messenger J, et al. Current difficulties in the diagnosis and management of spinal tuberculosis. Postgrad Med J. Jan 2006;82(963):46-51. [Medline].

  12. Jellis JE. Human immunodeficiency virus and osteoarticular tuberculosis. Clin Orthop Relat Res. May 2002;27-31. [Medline].

  13. Ridley N, Shaikh MI, Remedios D, et al. Radiology of skeletal tuberculosis. Orthopedics. Nov 1998;21(11):1213-20. [Medline].

  14. Sharif HS, Morgan JL, al Shahed MS, et al. Role of CT and MR imaging in the management of tuberculous spondylitis. Radiol Clin North Am. Jul 1995;33(4):787-804. [Medline].

  15. Moorthy S, Prabhu NK. Spectrum of MR imaging findings in spinal tuberculosis. AJR Am J Roentgenol. Oct 2002;179(4):979-83. [Medline].

  16. Almeida A. Tuberculosis of the spine and spinal cord. Eur J Radiol. Aug 2005;55(2):193-201. [Medline].

  17. Jung NY, Jee WH, Ha KY, et al. Discrimination of tuberculous spondylitis from pyogenic spondylitis on MRI. AJR Am J Roentgenol. Jun 2004;182(6):1405-10. [Medline].

  18. Weaver P, Lifeso RM. The radiological diagnosis of tuberculosis of the adult spine. Skeletal Radiol. 1984;12(3):178-86. [Medline].

  19. MRC Working Party on Tuberculosis of the Spine. Controlled trial of short-course regimens of chemotherapy in the ambulatory treatment of spinal tuberculosis. Results at three years of a study in Korea. Twelfth report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg Br. Mar 1993;75(2):240-8. [Medline].

  20. Blumberg HM, Burman WJ, Chaisson RE, et al. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med. Feb 15 2003;167(4):603-62. [Medline].

  21. [Best Evidence] Jutte PC, Van Loenhout-Rooyackers JH. Routine surgery in addition to chemotherapy for treating spinal tuberculosis. Cochrane Database Syst Rev. Jan 25 2006;CD004532. [Medline].

  22. Jain AK. Tuberculosis of the spine. Clin Orthop Relat Res. Jul 2007;460:2-3. [Medline].

  23. Watts HG, Lifeso RM. Tuberculosis of bones and joints. J Bone Joint Surg Am. Feb 1996;78(2):288-98. [Medline].

  24. Moon MS. Tuberculosis of the spine. Controversies and a new challenge. Spine. Aug 1 1997;22(15):1791-7. [Medline].

  25. Rajasekaran S, Prasad Shetty A, Dheenadhayalan J, et al. Morphological changes during growth in healed childhood spinal tuberculosis: a 15-year prospective study of 61 children treated with ambulatory chemotherapy. J Pediatr Orthop. Nov-Dec 2006;26(6):716-24. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

Pott’s disease, Pott disease, tuberculous spondylitis, spinal tuberculosis, spinal TB, TB, disk disease, vertebral collapse, kyphosis, kyphotic deformity, musculoskeletal tuberculosis, cold abscess, bone tuberculosis, soft-tissue tuberculosis, tuberculosis of the spine, osteomyelitis, arthritis, spinal deformity

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Jose A Hidalgo, MD, Assistant Professor, Universidad de San Marcos Medical School; Attending Physician, Department of Internal Medicine, Division of Infectious Diseases, Guillermo Almenara Hospital
Jose A Hidalgo, MD is a member of the following medical societies: HIV Medicine Association of America and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Coauthor(s)

George Alangaden, MD, Staff Physician, Associate Professor, Department of Internal Medicine, Division of Infectious Diseases, Detroit Medical Center, Wayne State University School of Medicine
George Alangaden, MD is a member of the following medical societies: American College of Physicians
Disclosure: Nothing to disclose.

Medical Editor

Thomas Herchline, MD, Professor of Medicine, Wright State University Boonshoft School of Medicine; Medical Director, Public Health, Dayton and Montgomery County, Ohio
Thomas Herchline, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Joseph F John Jr, MD, FACP, FIDSA, FSHEA, Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center
Disclosure: BioMerieux Honoraria Review panel membership; Cubist Honoraria Review panel membership; Pfizer Honoraria Speaking and teaching; Merck Stock dividends stock holdings

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.