Pott's Disease (Spinal Tuberculosis)

What is Pott’s disease?

Pott’s disease (spinal tuberculosis) is a bacterial infection that affects the bones in your spine (vertebrae). It’s a type of tuberculosis (TB), specifically a type of extrapulmonary TB. This means the TB infection doesn’t stay in your lungs. Pott’s disease starts in your lungs before it moves to your spine.

You may experience chronic (long-lasting) back pain and muscle weakness in your arms and legs. It can lead to a curved spine or damaged vertebrae. Pott’s disease can be fatal in some cases.

A healthcare provider may refer to Pott’s disease as Pott’s spine or tuberculosis spondylitis.

How common is Pott’s disease?

Pott’s disease is the most common form of tuberculosis that affects the bones. Around the world, TB affected an estimated 10.6 million people in 2022

What are Pott’s disease symptoms?

Symptoms of Pott’s disease include:

• Back pain.
• Neck pain.
• Arm and leg weakness.
• Loss of appetite.
• Unexplained weight loss.
• Fever.

Which bones does Pott’s disease affect?

Pott’s disease can affect any bone, or vertebra, in your spine. It usually affects more than one vertebra. You’ll most likely have symptoms in any of the following regions:

• Cervical spine (neck).
• Thoracic or dorsal spine (mid back).
• Lumbar spine (lower back).

What causes Pott’s disease?

The bacterium Mycobacterium tuberculosis causes Pott’s disease. You can develop Pott’s disease after inhaling (breathing in) droplets of TB-causing bacteria from someone who has a TB infection. The infection starts in your lungs and moves to the bones in your spine via your bloodstream.

Is Pott’s disease contagious?

Pott’s disease isn’t contagious. Tuberculosis is contagious when it’s in your lungs. It spreads in the air when someone who has the infection coughs or talks, for example. TB completely leaves your lungs by the time the infection spreads to your spine.

What are the risk factors for Pott’s disease?

You may be more at risk of developing Pott’s disease if you have exposure to someone who has TB, live in a crowded area (high population density) or have limited access to healthcare. People with certain health conditions have an increased Pott’s disease risk, including:

• Malnutrition.
• Substance use disorder.
• Conditions that compromise your immune system (like HIV).

What are the complications of Pott’s disease?

If it’s not treated, Pott’s disease can damage the bones in your spine. The bacteria create inflammation (swelling) and pus-filled pockets (abscesses) in your spinal column. The swelling and abscesses press against the bones in your spine, which weakens and damages them. Vertebrae can break and collapse, which makes your spine unstable. This leads to kyphosis, or a curved spine, that makes it look like you’re hunched over.

Pott’s disease can also lead to the following complications:

• Difficulty moving or walking.
• Nerve compression (weakness, numbness, loss of bladder or bowel control).
• Paralysis.
• Infection spreads to other parts of your body (like your brain and kidneys).

An early diagnosis and treatment can prevent these complications.

How is Pott’s disease diagnosed?

A healthcare provider will diagnose Pott’s disease after a physical exam and testing. They’ll learn more about your symptoms during the exam and use the following tests to rule out conditions with similar symptoms and confirm spinal TB:

• Tuberculosis skin test.
• Blood tests to detect TB bacteria.
• Imaging tests like a spine X-ray, a magnetic resonance imaging (MRI) test, a computed tomography (CT) scan or a positron emission tomography (PET) scan.

Pott’s disease symptoms are similar to symptoms of several other common conditions. Spinal TB is rare, so many cases don’t get an accurate diagnosis right away. In addition, tuberculosis is common in parts of the world where there’s limited access to healthcare. This means that some people are less likely to seek immediate treatment until they experience complications.

How is Pott’s disease treated?

Treatment for Pott’s disease happens in stages by taking certain medications over several months. Your healthcare provider might recommend taking the following chemotherapy medications:

• Isoniazid, rifampicin, pyrazinamide, ethambutol and/or streptomycin for two months.
• Continuing isoniazid and rifampicin for four to 12 months or longer.

Always follow your provider’s instructions to take medications for TB as directed. Stopping medications early can make treatments less effective.

Sometimes, the first line of medications to treat TB aren’t successful. This is known as drug-resistant TB. If this is the case, your provider might recommend the following medications:

• Kanamycin.
• Capreomycin.
• Pyrazinamide.
• Amikacin.
• Fluoroquinolone.

There are possible side effects from taking medications for drug-resistant TB. Your provider will let you know what to look out for.

Pott’s disease surgery

Surgery might be necessary to repair your spine, reduce symptoms and prevent complications of Pott’s disease. Types of surgery may include:

• Debridement: Cleaning or removing damaged tissue around your spine.
• Drainage: Removing or draining the pus-filled abscesses collected in your spinal column.
• Stabilization and alignment: TB can destroy or damage vertebrae. A surgeon may remove and/or repair broken bones and disks and add plates and screws to hold your bones in place.
• Fusion: A surgeon may permanently join two vertebrae together to limit their movement, which can prevent pain and other complications. Your surgeon may use a piece of bone from another part of your body (a bone graft) to help the two vertebrae fuse together.

Can Pott’s disease be prevented?

As a type of tuberculosis infection, you can’t entirely prevent Pott’s disease. But you can take steps to reduce your risk of getting a TB infection by:

• Avoiding prolonged, close contact with someone who has an active TB infection.
• Getting tested for TB regularly if you have an increased risk of TB or live in an area of the world where infection is more common.

What’s the outlook for Pott’s disease?

If detected and treated early, Pott’s disease has a positive outlook. An estimated 95% of people diagnosed with Pott’s disease who receive treatment early during its course recover from it.

If spinal tuberculosis progresses or doesn’t respond to medications and damages your spine, your prognosis may be fatal. Your provider will evaluate your outcome based on your age, your immune system’s response and your general health.

Can Pott’s disease be cured?

Pott’s disease can be cured with medications. A cure isn’t possible in all situations, especially if the TB is drug-resistant.

What is the life expectancy of someone with Pott’s disease?

Your life expectancy after Pott’s disease can vary widely. Pott’s disease may not affect your life expectancy if a provider diagnoses and treats it early. Pott’s disease outcomes are usually poor and even life-threatening in young children, adults older than 65 and people with weakened immune systems.

Your provider can give you the best information related to your life expectancy based on the following factors:

• Your age and general health.
• When you received treatment.
• The infection’s severity.
• in which complications you experience.
• If your body is resistant to TB medications.

When should I see a healthcare provider?

A tuberculosis infection starts in your lungs (pulmonary TB). Pott’s syndrome symptoms usually appear after the infection moves from your lungs to your spine. Contact a healthcare provider if you notice the following symptoms:

• A persistent cough (lasting more than two weeks).
• Chest pain.
• Coughing up blood.
• Fatigue.
• Muscle weakness.
• Loss of appetite.
• Fever and chills.

You may not experience any symptoms that affect your lungs, but you can still have TB. Let a provider know if you have any symptoms of spinal tuberculosis right away.

What questions should I ask my healthcare provider?

• Do I have Pott’s disease or another condition that affects my spine?
• What treatment do you recommend?
• When and how often should I take medication for TB?
• Are there side effects of the medication?
• Do I need surgery?