Tuberculous Spondylitis Treatment

Tuberculous spondylitis or Pott disease is one of the oldest demonstrated diseases of humankind, having been documented in spinal remains from the Iron Age in Europe and in ancient mummies from Egypt and the Pacific coast of South America. In 1779, Percivall Pott, for whom the disease is named, presented the classic description of spinal tuberculosis.

Signs and symptoms

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

Treatment

• Triple therapy:
  • Streptomycin: initial 2-3 mths
  • Isoniazid: 9 mths
  • Rifampicin: 9 mths

• Commence antibiotics ~ 1 wk prior to surgery
• Indications for nonsurgical treatment alone are patients with early disease with minimal bone involvement and medical contraindications to operation
• Surgery is indicated in all others - especially in the paraplegia of active disease
• Surgery - recommended is the Hong-Kong operation- consists of excision of the disease focus and strut grafting
  • advantages:
    • adequate material for analysis
    • prevention of progression of abscess
    • relieve pressure on neural tissue
    • graft under compression - fusion almost sure- thus late kyphosis prevented.