P O T T S DISEASE

Pembuat :
TONDO BAYU (11-2011-048)
MERCY SYLVIA (11-2012-009)

Pembimbing :
dr. Suhana, SpOT
 POTTs DISEASE
Definition
Potts disease is a presentation of extrapulmonary
tuberculosisthat affects the spine, a kind of
tuberculous arthritis of the intervertebral joints.
It is named after Percivall Pott(1714-1788), a
London surgeon who trained at Barts.
Scientifically, it is called tuberculous
spondylitisand it is most commonly localized in
the thoracic portion of the spine.
AKA:Pott's syndrome, Pott's caries, Pott's
curvature, angular kyphosis, kyphosis secondary
to tuberculosis, tuberculosis of the spine,
tuberculous spondylitis and David's disease
 POTTs DISEASE

Etiology
Pottsdiseaseis caused when the
vertebraebecome soft and collapse
as the result of caries or osteitis.
Typically, this is caused by
mycobacteriumtuberculosis. As a
result, a person
withPott'sdiseaseoften develops
kyphosis, which results in a
hunchback.
Pathophysiology Of
Tuberculous Spondylitis
 Tuberculous spondylitis

Cold Abscesses
Not as hot, warm or painful as
other abscesses
Hidden deep inside the body

May burst out leaving behind a

track, or sinus, which discharges
pus
 POTTs DISEASE

Epidemiology
Approximately 1-2% of total tuberculosis cases are
attributable to Potts disease. The incidence rate here in
the Philippines is approximately 20-30% of the entire
patient diagnosed to have Tuberculosis. Most of the
cases of the Pott's disease in the Philippines are caused
by the non-compliance of the treatment regimen of TB.
Tuberculosis worldwide accounts for 1.7 billion
infections, and 2 million deaths per year. Over 90% of
TB occurs in poorer countries, but a global resurgence is
affecting richer ones.
The disease affects males more than females in a ratio
of between 1.5 and 2:1.
In the USA it affects mostly adults but in the countries
where it is commonest it
affects mostly children.
 POTTs DISEASE

Risk Factors
Tuberculosis/Endemic TB
Poor socioeconomic conditions
Diabetes
Steroid Use
Chronic Disease
Immunosuppression
IV drug Abuse
Rheumatoid Arthritis
 POTTs DISEASE
Signs and Symptoms
Localized back pain
Paravertebral swelling
Systematic signs and symptoms of TB
Neurological signs may occur leading to
paraplegia
Spinal mass, sometimes associated with
numbness, tingling, or muscle weakness
of the leg
POTTS DISEASE
POTTS DISEASE
POTTS DISEASE
 PHYSICAL ASSESSMENT

Body Parts Actual Findings Analysis

Height Change of shape of kyphosis

back

Weight Weight loss Anorexia

Vital signs Normal Findings Actual Findings Analysis

Temperature 36.5-37.5 degrees Increase in

Celsius temperature Febrile

General Survey
Normal Findings Actual Findings Analysis

Body built mesomorph Ectomorph Deviation from

Normal
Overall hygiene clean and neat Self bathing Deviation from
and grooming hygiene deficit Normal

POTTS DISEASE
 PHYSICAL ASSESSMENT

Assessment of the Skin

Normal Findings Actual Findings Analysis

Varies from light to deep

brown; from ruddy pink to
light pink; from yellow
overtones to olive
Skin color redness erythema
-Fundamentals of Nursing
8th edition Kozier and Erbs
page 579

No edema

Presence of edema -Fundamentals of Nursing with edema edema

8th edition Kozier and Erbs
page 579

Uniform: within normal

range
Febrile
Skin temperature Warm skin temperature
-Fundamentals of Nursing
Deviation from Normal
8th edition Kozier and Erbs
page 579
 PHYSICAL ASSESSMENT

Assessment of the Nose

Palpate the maxiliary Tenderness in one or

Not tender Deviation from normal
and frontal sinuses for more sinuses
tenderness

Assessment of the Thorax

Posterior Thorax Normal Findings Actual Findings Analysis

Spine is vertically
aligned. Spinal column
is straight, right and left
Inspect the spinal shoulder and hips are at
the same height. Exaggerated spinal Kyphosis due to
alignment for
curvatures gibbous formation
deformities. - Fundamentals of
Nursing 8th edition
Kozier and Erbs page
614
Palpate the posterior No tenderness, no Pain with palpation over
Deviation from normal
thorax masses the spine
 PHYSICAL ASSESSMENT
Assessment of the Musculoskeletal System
Inspect the muscle for size.
Test muscle strength.
Assess range of motion
Bones
Inspect the skeleton for
structure
Palpate the bones to locate any
No tenderness or swelling
areas of edema or tenderness
Joints
Inspect the swelling. Palpate
each joint for tenderness,
smoothness of movement,
swelling, crepitation, and
presence of nodules.
Assess joint range of motion
Normal Findings Actual Findings Analysis
Equal in size on both body parts.
Muscle atrophy Deviation from Normal
- Fundamentals of Nursing 8th
edition Kozier and Erbs page 640
Equal strength on each body sides
( sternocleidomastoid, trapezius,
deltoid, biceps, triceps, wrist and
finger, grip strength, hip and Weakness Deviation from Normal
hamstring.
- Fundamentals of Nursing 8th
edition Kozier and Erbs page 640
Varries in accordance to a person
genetic make-up Fundamentals of Decrease range of motion. Pain in
Deviation from Normal
Nursing 8th edition Kozier and Erbs movement
page 641
No deformities Bones misaligned Deviation from normal
Presence of tenderness or swelling Deviation from normal
No swelling
No tenderness, crepitation or
Swelling joints Deviation from Normal
nodules
Joints move smoothly
Varies to some degree in
accordance with persons genetic
Decreased range of motion Deviation from normal
make-up and degree of physical
activity
DIAGNOSTICS
Diagnosis
Blood cp( ESR)

Range of motion in the spine.

A series of neurological tests

complete medical history

blood immunoglobin profile

X-rays

magnetic resonance images (MRIs)

CT scan guided biopsy

Bone scans
 DIAGNOSTIC PROCEDURE

Blood Test- elevated ESR

Tuberculine Test
Radiographs of the spine
Bone Scan
CT of the Spine
Bone biopsy

MICROBIOLOGY
Needle biopsy
Acid-fast strain and culture
 DIAGNOSTIC PROCEDURE
Imaging Studies

CT scanning
CT scanning provides much better bony detail of
irregular lytic lesions, sclerosis, disk collapse, and
disruption of bone circumference.
Low-contrast resolution provides a better
assessment of soft tissue, particularly in epidural
and paraspinal areas.

MRI
MRI is the criterion standard for evaluating disk-
space infection and osteomyelitis of the spine and is
most effective for demonstrating the extension of
disease into soft tissues and the spread of
tuberculous debris under the anterior and posterior
longitudinal ligaments. MRI is also the most
effective imaging study for demonstrating neural
compression.
 LABORATORY RESULTS:
Laboratory Studies

Tuberculin skin test (purified protein

derivative [PPD])-
Results are positive in 84- 95% of patients with Pott
disease who are not infected with HIV

The erythrocyte sedimentation rate (ESR)

May be markedly elevated (>100mm/h).

Microbiology studies
Are used to confirm diagnosis. Bone tissue or
abscess samples are obtained to stain for acid-fast
bacilli (AFB), and organisms are isolated for culture
and susceptibility. CT-guided procedures can be
used to guide percutaneous sampling of affected
bone or soft-tissue structures. These study findings
are positive in only about 50% of the cases.
 LABORATORY RESULTS

Aspirate from joint space &

abscess
Transparency: turbid.
Colour: creamy.
Consistency: cheesy.
Fibrin clot: large.
Mucin clot: poor.
WBC: 25000/cc.mm.
 LABORATORY RESULTS
Imaging Studies
Radiography
Radiographic changes associated with Pott disease
present relatively late. The following are
radiographic changes characteristic of spinal
tuberculosis on plain radiography:
Lytic destruction of anterior portion of vertebral
body
Increased anterior wedging
Collapse of vertebral body
Reactive sclerosis on a progressive lytic process
Enlarged psoas shadow with or without
calcification

Additional radiographic findings may include the

following:
Vertebral end plates are osteoporotic.
Intervertebral disks may be shrunk or destroyed.
Vertebral bodies show variable degrees of
destruction.
Fusiform paravertebral shadows suggest abscess
formation.
Bone lesions may occur at more than one level.
 LABORATORY RESULTS
Imaging Studies

X-Ray spine

Early:-
Narrowed joint space.
Diffuse vertebral osteoporosis adjacent
to joint.
Erosion of bone.
Fusiform paraspinal shadow of abscess
in soft tissue.

Late:-
Destruction of bone.
Wedge-shaped deformity (collapse of
vertebrae anteriorly).
Bony ankylosis.
 LABORATORY RESULTS
Imaging Studies

CT SCAN
CT scanning reveals early lesions and is
more effective for defining the shape and
calcification of soft-tissue abscesses.
In contrast to pyogenic disease,
calcification is common in tuberculous
lesions.

MRI
MRI findings useful to differentiate
tuberculous spondylitis from pyogenic
spondylitis include thin and smooth
enhancement of the abscess wall and well-
defined paraspinal abnormal signal,
whereas thick and irregular enhancement
of abscess wall and ill-defined paraspinal
abnormal signal suggest pyogenic
spondylitis. Thus, contrast-enhanced MRI
 DIFFERENTIAL DIAGNOSIS

Osteitis Piogen
Poliomielitis
Skoliosis idiopatik
Metastasis spinal cord
Pulmo infection after empiema
Kifosis senilis
Complication
Spinal cord injury
Empyema tuberculosis
 Treatment

Drug treatment

Bed rest

Spinal braces

Surgery