Pott's disease natural history, complications and prognosis

Pott’s disease may be complicated by severe vertebral deformity and collapse resulting in kyphosis, cord compression, and paraplegia. It responds well to treatment with improvement of the neurological function and spinal deformity.

Spinal tuberculosis is one of the common extra-pulmonary manifestation involving the skeletal system. The common affected sites include the upper lumbar and lower thoracic spine. The infection affects the body of the vertebra or the the intervertebral discs. The progression of the disease is slow with a wide variation in the time of infection to manifest the clinical symptoms of the disease . The average disease duration ranges from 4 to 11 months. Patients take medical help when they develop severe pain, marked deformity or neurological symptoms.^[1][2]

The destruction of the intervertebral disc, body of the vertebra and spread of the infection can result the following complications:^[1][3][4]

• Vertebral collapse resulting in kyphosis
• Spinal cord compression
• Paraplegia (so called Pott’s paraplegia) or tetraplegia can result from spinal cord compression.
• Formation of a cold abscess when the infection spreads to the adjacent ligaments. ^[5]
• Cold abscess in the cervical spine, can cause the spread of infection to form a retropharyngeal abscess.
• The infection can spread to the mediastinum or trachea when the abscess develops in the thoracic spine.
• Infection can spread down the sheath of the psoas muscle to the femoral trigone to form a sinus .

Pott’s disease responds well to treatment with antitubercular treatment. Improvement in pain and neurological deficits are indicators for response to treatment. Prognosis is good in all patients, if a lack of improvement persists other differential must be considered. If other differentials are ruled out and medical therapy is not successful surgery is considered and it has good prognosis.^[6]

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