Pott Disease (Tuberculous [TB] Spondylitis) Clinical Presentation

Updated: Aug 08, 2019
  • Author: Jose A Hidalgo, MD; Chief Editor: John L Brusch, MD, FACP  more...
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Presentation

History

The presentation of Pott disease depends on the following [22] :

  • Stage of disease
  • Affected site
  • Presence of complications such as neurologic deficits, abscesses, or sinus tracts

Patients with Pott disease may have history of pulmonary tuberculosis or concomitant disease. A large 2019 series reported that 26.6% of patients had concomitant pulmonary tuberculosis. [23]

Potential constitutional symptoms of Pott disease include fever and weight loss. The reported average duration of symptoms at diagnosis is 4 months [18] but can be considerably longer. [20, 24] This is due to the nonspecific presentation of chronic back pain.

Back pain is the earliest and most common symptom of Pott disease, with patients usually experiencing this problem for weeks before seeking treatment. The pain caused by Pott disease can be spinal or radicular.

Neurologic abnormalities occur in 50% of cases and can include spinal cord compression with paraplegia, paresis, impaired sensation, nerve root pain, and/or cauda equina syndrome.

Cervical spine tuberculosis is a less common presentation but is potentially more serious because severe neurologic complications are more likely. This condition is characterized by pain and stiffness. Patients with lower cervical spine disease can present with dysphagia or stridor. Symptoms can also include torticollis, hoarseness, and neurologic deficits.

The clinical presentation of spinal tuberculosis in patients infected with the human immunodeficiency virus (HIV) is similar to that of patients who are HIV negative; however, spinal tuberculosis seems to be more common in persons infected with HIV. [25]

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Physical Examination

The physical examination in Pott disease should include the following:

  • Careful assessment of spinal alignment

  • Inspection of skin, with attention to detection of sinuses

  • Abdominal evaluation for subcutaneous flank mass

  • Meticulous neurologic examination

Although the thoracic and lumbar spinal segments are nearly equally affected in persons with Pott disease, the thoracic spine is frequently reported as the most common site of involvement. Together, these segments make up 80-90% of spinal tuberculosis sites, with the remaining cases of Pott disease occurring in the cervical spine. [19, 20, 22] Almost all patients with Pott disease have some degree of spine deformity (kyphosis).

Examination should reveal local pain related to the affected area or radicular pain. Muscle spasm and rigidity can also be associated.

Large, cold abscesses of paraspinal tissues or psoas muscle may protrude under the inguinal ligament and may erode into the perineum or gluteal area.

Neurologic deficits may occur early in the course of Pott disease. Signs of such deficits depend on the level of spinal cord or nerve root compression.

Pott disease that involves the upper cervical spine can cause rapidly progressive symptoms. Retropharyngeal abscesses occur in almost all cases affecting this part of the spine. Neurologic manifestations occur early and range from a single nerve palsy to hemiparesis or quadriplegia.

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.

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