Potts Disease

Submitted to: Mrs. Campita, Nurse III Submitted by: Esther Joanna J. Ricamara School: St. Josephs College of Quezon City

Overview of the disease

Pott's disease is a spine infection associated with tuberculosis that is characterized by bone
destruction, fracture, and collapse of the vertebrae, resulting in kyphotic deformity. Is the presentation of the extra-pulmonary tuberculosis arthritis of the intervertebral joints Also called tuberculosis spondylitis (from the word spondyl, meaning vertebrae), spinal TB, musculoskeletal tuberculosis. The causative agent is Mycobacterium Tubercule particularly the lower thoracic and the upper lumbar regions are affected.

It has been documented in ancient mummies form the Egypt and Peru and is one of the oldest demonstrated diseases of the humankind. Percival Pott presented the classic description of spinal tuberculosis in 1779. Since the advent of antituberculous drugs and improved public health measures, spinal tuberculosis has become rare in industrialized countries, although it is still a significant cause of disease in developing countries. Tuberculous involvement of the spine has the potential for serious morbidity, including permanent neurological deficits and severe deformity. Medical treatment or combined medical and surgical can control the disease in most patients. Although some series found a similar proportion of affected men and women, males are more often affected. In the Philippines , Potts disease primarily occurs in adults. In countries with higher rates in infection, it mainly occurs in children. It is commonest in groups whose living conditions are substandard.

Types of Potts Disease: 1. 2. 3. a. b. c. d. Cervical Thoracic Lumbo-sacral Potts Cervical and Upper Dorsal Region (Signs and Symptoms) Pain and malaise with loss of weight accompanied by wasting of the back muscles. Limited neck movement Swelling and abscess may be palpated in the region. Gibbus formation (Pathognomonic sign)

Etiology and Risk Factors 1. 2. 3. 4. 5. 6. Home Environment Conditions Family History of Pulmonary Tuberculosis Nutritional Status Gender (Male) Age (10 yrs. Old and above) No full immunization

Diagnostic Procedures

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 8495% of patients with Pott disease.

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: 1. 2. 3. 4. Destruction of anterior portion of vertebral body Increased anterior wedging Collapse of vertebral body Reactive sclerosis on a progressive process

5. Enlarged psoas shadow with or without calcification Additional radiographic findings may include the following: 1. 2. 3. 4. 5. Vertebral end plates are osteoporotic. Intervertebral discs may be shrunk or destroyed. Vertebral bodies show variable degrees of destruction. Fusiform vertebral shadows suggest abscess formation. Bone lesions may occur at more than one level.

CT of the spine a. CT scanning provides much bony detail of irregular lesions, sclerosis, disc collapse, and disruption of bone circumference. b. Low-contrast resolution provides a better soft tissue assessment, particularly in epidural and spinal areas. c. It detects early lesions and is more effective for defining the shape and calcification of soft tissue abscess. d. In contrast to pyogenic disease, calcification is common in tuberculous lesions.

MRI a. MRI is the criterion standard for evaluating disc space infection and osteomyelitis of the spine and is most effective for demonstrating the extension of disease into soft tissues and the spread of tuberculous debris under the anterior and posterior longitudinal ligaments. b. MRI is most effective for demonstrating neural compression. c. In developed countries, MRI has nearly replaced CT myelography.

Treatment and Management

Treatment and Management

Non-operative antituberculous drugs Phase Duration Drug

Intensive

5-6 months

Rifampicin ofloxacin400-600mg / streptomycin

Continuation

7-8 months

3-4mth Pyrazinamide 4-5mth Rifampicin

1500mg

Prophylactic

4-5 months

Ethambutol 1200mg

Analgesics Immobilization of the spine region different types of braces. >Taylor Brace >Lumbar Brace

Surgery may be necessary, especially to drain spinal abscesses or debride bony lesions fully or to stabilize the spine. 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

Nursing Care Independent Monitor Vital Signs for baseline purposes. Investigate reports of pain, noting location and intensity (Pain Scale of 0-10). Note precipitating factors and nonverbal pain cues. Provide comfort measures, e.g., gentle massage, helping patient assume position of comfort. Reposition in bed every 2 hrs. Inspect skin for presence of cold abscess. Keep skin clean and dry. Keep linens dry and wrinkle free.\ Check brace setup. Instruct and assist with active/passive ROM exercise for all unaffected joints. Promote deep breathing and coughing exercise. Involve patient in diversional activities appropriate situation. Encourage patient to verbalize concerns and feelings. Provide information about specific procedures and tests and what to expect afterwards. Be aware of how much information patient wants. Reinforce previous information patient has been given. Auscultate bowel sounds. Note consistency/frequency of bowel movement (BMs), presence and abdominal distension. Suggest adding fresh fruits, vegetable, and fiber to diet (with restrictions) when indicated. Provide privacy at bedside commode. Collaborative Administer medications as ordered by the doctor. Assist with physical therapy Provide a balance diet of complex carbohydrates and ordered amount of high quality protein and essential amino acids. Administer multivitamins as ordered by the doctor.