From the Guidelines
Pott's (Spinal Tuberculosis) myelopathy is a severe neurological complication of spinal tuberculosis that most often responds to chemotherapy, with or without functional impairment, and does not necessarily require surgical intervention.
Definition and Treatment
Pott's myelopathy is characterized by neurological deficits due to compression or inflammation of the spinal cord, and its treatment should prioritize chemotherapy as the primary approach, as evidenced by the Medical Research Council studies conducted in Korea, where 24 of 30 patients in one study and 74 of 85 patients in an earlier study had complete resolution of myelopathy or complete functional recovery when treated medically 1.
Key Considerations
- The use of anti-tuberculosis medication is crucial in treating Pott's myelopathy, with regimens containing Rifampicin (RIF) being at least as effective as longer regimens without RIF 1.
- Surgical intervention may be beneficial in certain situations, such as failure to respond to chemotherapy, relief of cord compression, or instability of the spine, but it is not the primary treatment approach for Pott's myelopathy 1.
- The treatment regimen should be tailored to the individual patient's needs, taking into account the severity of the neurological deficits and the presence of any other complications.
Treatment Approach
Some key points to consider in the treatment of Pott's myelopathy include:
- Chemotherapy as the primary treatment approach
- Use of anti-tuberculosis medication, such as RIF, for at least 6-9 months
- Surgical intervention only in specific situations, such as failure to respond to chemotherapy or relief of cord compression
- Supportive care, including corticosteroids and physical therapy, to reduce inflammation and promote neurological recovery.
From the Research
Definition and Overview of Pott's (Spinal Tuberculosis) Myelopathy
- Pott's (Spinal Tuberculosis) myelopathy is not directly defined in the provided studies, but myelopathy in general refers to a clinical syndrome caused by compression, injury, or congenital changes in the spinal cord [ 2 ].
- Myelopathy can result from various etiologies, including degenerative, traumatic, and infectious causes [ 3 ].
Clinical Presentation and Diagnosis
- The clinical presentation of myelopathy can vary, with symptoms ranging from mild to severe and including motor weakness, sensory loss, and bladder and bowel dysfunction [ 3 ].
- Diagnosis of myelopathy involves a combination of clinical evaluation, imaging studies (such as MRI), and sometimes laboratory tests to determine the underlying cause [ 4 ].
Treatment and Management
- Treatment of myelopathy depends on the underlying cause and severity of symptoms [ 2 ].
- Surgical intervention may be necessary for compressive myelopathies, while medical treatment is often used for intrinsic myelopathies [ 4 ].
- For degenerative cervical myelopathy, surgery can prevent further deterioration, but biological therapies may be required to restore neurological function in advanced disease [ 5 ].