What is Pott's syndrome (Spinal tuberculosis)?

From the Guidelines

Pott's syndrome, also known as tuberculous spondylitis or spinal tuberculosis, is an infection of the spine caused by Mycobacterium tuberculosis that requires prompt antitubercular therapy and potentially surgical intervention to prevent morbidity and mortality. The disease typically affects the thoracic and lumbar vertebrae, causing vertebral destruction, collapse, and potential spinal cord compression 1. Treatment of Pott's syndrome involves a multidisciplinary approach, with antitubercular therapy as the cornerstone, and may include a four-drug combination for 2 months, followed by isoniazid and rifampin for an additional 10-16 months. Some key points to consider in the treatment of Pott's syndrome include:

• The use of 6- to 9-month regimens containing rifampin, which have been shown to be at least as effective as 18-month regimens that do not contain rifampin 1
• The potential benefits of surgical debridement or radical operation in combination with chemotherapy, although a randomized trial by the Medical Research Council Working Party on Tuberculosis of the Spine found no additional benefit of these procedures compared to chemotherapy alone 1
• The importance of early diagnosis and treatment to prevent permanent neurological damage and spinal deformities
• The need for regular follow-up to monitor treatment response and adjust the treatment plan as necessary In terms of specific treatment recommendations, a 9-month duration of antitubercular therapy may be favored by some experts due to the difficulties in assessing response to treatment 1. Additionally, surgical intervention may be indicated in cases with neurological deficits, spinal instability, or significant deformity 1. Overall, the goal of treatment for Pott's syndrome is to prevent morbidity and mortality, and to improve quality of life for patients with this condition.

From the Research

Definition and Causes of Pott's Syndrome

• Pott's syndrome, also known as spinal tuberculosis, is an extrapulmonary form of tuberculosis caused by Mycobacterium TB 2.
• It is usually caused by the hematogenous spread of infection from a central focus, which can be in the lungs or another location 2.
• The disease involves the intervertebral disc and can result in severe morbidity even after years of approved therapy 2.

Clinical Features and Diagnosis

• The clinical, radiographic, microbiological, and histological data are used to make the diagnosis of spinal TB 2.
• Common complications include abscesses, neurologic deficits, spinal instability, and spinal deformity 3.
• Lumbar, thoracic, and thoracolumbar vertebrae are the most commonly involved sites of infection 3.

Treatment Options

• Combination multidrug antitubercular therapy is the basis of treatment for Pott's disease 2.
• Surgical treatment is necessary for patients with significant kyphosis or neurological impairments 2, 4.
• Debridement, fusion stabilization, and correction of spinal deformity are the cornerstones of surgical treatment 2.
• Medical treatment alone may be effective in some cases, especially in patients without neurological deficits or spinal deformity 5.

Outcomes and Prognosis

• Clinical results for the treatment of spinal TB are generally quite good with adequate and prompt care 2.
• Older age, presence of neurologic deficit, and spinal deformity are predictors of unfavorable outcome 3.
• Early establishment of definitive aetiologic diagnosis and appropriate treatment are of paramount importance to prevent development of sequelae 3.