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Pott disease, also known as tuberculous spondylitis, is one of the oldest demonstrated

diseases of humankind, having been documented in spinal remains from the Iron Age in
Europe and in ancient mummies from Egypt and the Pacific coast of South America. [1, 2] In
1779, Percivall Pott, for whom the disease is named, presented the classic description of
spinal tuberculosis. (See the image below.)[3]

MRI of a 31-year-old man with


tuberculosis of the spine. Images show the thoracic spine before and after an infusion of intravenous
gadolinium contrast. The abscess and subsequent destruction of the T11-T12 disc interspace is marked with
arrowheads. Vertebral body alignment is normal. Courtesy of Mark C. Diamond, MD, and J. Antonio
Bouffard, MD, Detroit, Mich.

Since the advent of antituberculous drugs and improved public health measures, spinal
tuberculosis has become rare in industrialized countries, although it is still a significant cause
of disease in developing nations. Tuberculous involvement of the spine has the potential to
cause serious morbidity, including permanent neurologic deficits and severe deformities.
Medical treatment or combined medical and surgical strategies can control the disease in
most patients.

Patient education
Patients with Pott disease should be instructed on the importance of therapy compliance. For
patient education information, see the Infections Center, as well as Tuberculosis.

Pathopysiology
Pott disease is usually secondary to an extraspinal source of infection. Pott disease
manifests as a combination of osteomyelitis and arthritis that usually involves more than 1
vertebra. The anterior aspect of the vertebral body adjacent to the subchondral plate is
usually affected. Tuberculosis may spread from that area to adjacent intervertebral disks. In
adults, disk disease is secondary to the spread of infection from the vertebral body. In
children, the disk, because it is vascularized, can be the primary site. [4]

Progressive bone destruction leads to vertebral collapse and kyphosis. The spinal canal can
be narrowed by abscesses, granulation tissue, or direct dural invasion, leading to spinal cord
compression and neurologic deficits.
The kyphotic deformity is caused by collapse in the anterior spine. Lesions in the thoracic
spine are more likely to lead to kyphosis than those in the lumbar spine. A cold abscess can
occur if the infection extends to adjacent ligaments and soft tissues. Abscesses in the lumbar
region may descend down the sheath of the psoas to the femoral trigone region and
eventually erode into the skin.