Pott disease is tuberculosis of the spine, usually due to haematogenous spread from other sites, often the lungs. The lower thoracic and upper lumbar vertebrae are the areas of the spine most often affected. It causes a kind of tuberculous arthritis of the intervertebral joints. The infection can spread from two adjacent vertebrae into the adjoining intervertebral disc space. If only one vertebra is affected, the disc is normal, but if two are involved, the disc, which is avascular, cannot receive nutrients and collapses. In a process called caseous necrosis the disc tissue dies leading to vertebral narrowing and eventually to vertebral collapse and spinal damage. A dry soft tissue mass often forms and superinfection is rare. Spread of infection from the lumbar vertebrae to the psoas muscle, causing abscesses, is not uncommon. The disease is named after Percivall Pott, the British surgeon who first described it in the late 18th century.
Controlling the spread of tuberculosis infection can prevent tuberculous spondylitis and arthritis. Patients who have a positive PPD test may decrease their risk by properly taking medicines to prevent tuberculosis. To effectively treat tuberculosis, it is crucial that patients take their medications exactly as prescribed.
Immobilization of the spine region using different types of braces and collars
Surgery may be necessary, especially to drain spinal abscesses or debride bony lesions fully or to stabilize the spine. A 2007 review found just two randomized clinical trials with at least one year-follow up found which compared chemotherapy plus surgery with chemotherapy alone for treating people diagnosed with active tuberculosis of the spine. As such there is no high grade evidence but the results of this study indicates that surgery should not be recommended routinely and clinicians have to selectively judge and decide on which patients to operate.
Thoracic spinal fusion with or without instrumentation as a last resort
Physical therapy for pain-relieving modalities, postural education and teaching a home exercise program for strength and flexibility
Søren Kierkegaard may have died from Pott disease, according to professor Kaare Weismann and literature scientist Jens Staubrand
Chick Webb, swing era drummer and band leader, was afflicted with tuberculosis of the spine as a child, which left him hunchbacked, and eventually caused his death.
Morton, the railroad magnate in Once Upon a Time in the West, has the disease and needs crutches to walk.
Writer Max Blecher had Pott's disease. His story is portrayed in the 2016 film Scarred Hearts.
Marxist thinker and Communist leader Antonio Gramsci had Pott's disease, probably due to the bad conditions of his incarceration in fascist Italy during the 1930s.
Italian writer, poet and philosopher Giacomo Leopardi had this disease.
It features prominently in the book This Is a Soul, which chronicles the work of American physician Rick Hodes in Ethiopia.
Imogen in the novella "The Princess with the Golden Hair", part of Memoirs of Hecate County by Edmund Wilson has Pott's disease.
