Discussion Author: Eric A Walker
In 1779, Percivall Pott presented the classic description of spinal tuberculosis.
Spinal tuberculosis is an important problem in developing countries, particularly in people under age 20. With the increase in foreign travel and immigration, and secondary to the appearance of AIDS, there has been an increase in the number of spinal tuberculosis in adults.
Pott's disease can lead to bone destruction, deformity and paraplegia. The lower thoracic vertebral bodies ar most frequently involved followed by the lumbar vertebra. The cervical spine is involved in about 10% of cases.
Back pain is the most common presenting symptom and may be present for weeks prior to diagnosis. The pain may mimic radicular disease.
A 4-drug regimen should be used to treat Pott disease. Treatment can be adjusted when susceptibility information becomes available. Isoniazid and rifampin should be administered during the whole course of therapy. Two additional drugs are usually administered during the first 2 months of therapy. These are generally chosen among the first-line drugs which include pyrazinamide, ethambutol, and streptomycin. Traditional courses range from 9 months to longer than 1 year.
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