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inflammation of a spinal joint; characterized by pain and stiffness

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結核（性）の・ゲッカコウ(月下香)(ヒガンバナ科の球根植物)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/01/08 08:51:39」(JST)

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"Pott's disease" redirects here. It is not to be confused with Postural orthostatic tachycardia syndrome, also known as "POTS".

Tuberculosis of the spine in an Egyptian mummy

Pott's disease or Pott disease is a presentation of extrapulmonary tuberculosis whereby disease is seen in the spinal vertebrae.^[1] Extrapulmonary tuberculosis can affect the spine, a kind of tuberculous arthritis of the intervertebral joints. It is named after Percivall Pott (1714–1788), a British surgeon. The lower thoracic and upper lumbar vertebrae are the areas of the spine most often affected. Scientifically, it is called tuberculous spondylitis and it is most commonly localized in the thoracic portion of the spine. Pott’s disease results from haematogenous spread of tuberculosis from other sites, often pulmonary. The infection then spreads 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. The disc tissue dies and is broken down by caseation, leading to vertebral narrowing and eventually to vertebral collapse and spinal damage. A dry soft tissue mass often forms and superinfection is rare.

Signs and symptoms[edit]

Back pain
Fever
Night sweating
Anorexia
Spinal mass, sometimes associated with numbness, paraesthesia, or muscle weakness of the legs
Difficulty standing

Diagnosis[edit]

Blood tests

– CBC: leukocytosis

– Elevated erythrocyte sedimentation rate: >100 mm/h

Tuberculin skin test

– Tuberculin skin test (purified protein derivative [PPD]) results are positive in 84–95% of patients with Pott disease who are not infected with HIV.

A girl from Oklahoma, who has been affected by bone tuberculosis, 1935

Radiographs of the spine

– 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.

Bone scan
CT of the spine
Bone biopsy
MRI

Late complications[edit]

Vertebral collapse resulting in kyphosis
Spinal cord compression
Sinus formation
Paraplegia (so called Pott's paraplegia)

Prevention[edit]

Controlling the spread of tuberculosis infection can prevent tuberculous spondylitis and arthritis. Patients who have a positive PPD test (but not active tuberculosis) 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.

Therapy[edit]

Non-operative – antituberculous drugs
Analgesics
Immobilization of the spine region 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 only just two randomized clinical trial 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. ^[2]
Thoracic spinal fusion with or without instrumentation as a last resort
Physical therapy for pain-relieving modalties, postural education and teaching a home exercise program for strength and flexibility

Cultural references[edit]

The fictional Hunchback of Notre Dame had a gibbous deformity (humpback) similar to the type caused by tuberculosis.
In Henrik Ibsen's play "A Doll's House," Dr. Rank suffers from "consumption of the spine."
Jocelin, the Dean who wanted a spire on his cathedral in William Golding's "The Spire" probably suffered and died as a result of this disease.
English poets Alexander Pope and William Ernest Henley both suffered from Pott's disease.
Anna Roosevelt Cowles, sister of president Theodore Roosevelt, suffered from Pott's Disease.
Chick Webb, swing era drummer and band leader, was afflicted with tuberculosis of the spine as a child, which left him hunchbacked.
The Sicilian mafia boss Luciano Leggio had Pott's disease and wore a brace.
Morton, the railroad magnate in Once Upon a Time in the West, suffers from the disease and needs crutches to walk.
Writer Max Blecher had Pott's Disease.
Marxist thinker and Communist leader Antonio Gramsci suffered from 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 suffered from 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 (1946) has Pott's disease.
Jane Addams, social activist and Nobel Peace Prize winner, had Pott's disease.

References[edit]

^ "Extrapulmonary Tuberculosis". TB Symptoms. 2013-01-18. Retrieved 2013-07-11.
^ Jutte PC, van Loenhout-Rooyackers JH. Routine surgery in addition to chemotherapy for treating spinal tuberculosis. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD004532. DOI: 10.1002/14651858.CD004532.pub2. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004532.pub2/abstract

External links[edit]

Pott Disease — Tuberculous Spondylitis (medical article with MRI picture), eMedicine .
"Tuberculous arthritis", MedlinePlus, USA: NIH . Public domain.
Pott disease
Pott's Disease of the Thoracic Spine

UpToDate Contents

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1. 骨格系結核 skeletal tuberculosis
2. 成人における強直性脊椎炎の評価および治療 assessment and treatment of ankylosing spondylitis in adults
3. 強直性脊椎炎、末梢関節炎を主体とする脊椎関節炎、およびX線所見が認められない軸性脊椎関節炎における抗腫瘍壊死因子α（TNF-α）剤使用のための一般的ガイドライン general guidelines for use of anti tumor necrosis factor alpha agents in ankylosing spondylitis and in peripheral and non radiographic axial spondyloarthritis
4. 胸壁疾患 diseases of the chest wall
5. 成人における慢性膝痛の放射線評価 radiologic evaluation of the chronically painful knee in adults

English Journal

PMID 22622797

[Specific spondylitis.]

Bullmann V, Liljenqvist UR, Koriller M, Lange T.SourceOrthopädische Klinik II - Wirbelsäulenchirurgie, St. Franziskus-Hospital, Schönsteinstr. 63, 50825, Köln-Ehrenfeld, Deutschland, viola.bullmann@st-franziskus-koeln.de.
Der Orthopade.Orthopade.2012 Aug 24. [Epub ahead of print]
Tuberculosis of the spine usually occurs with a latency period after primary infection with tuberculosis (TB) and the most frequent agent is Mycobacterium tuberculosis. The rate of TB has increased due to the impact of acquired immunodeficiency syndrome (AIDS) and more than 50% of skeletal tuberculo
PMID 22914915