Potts Disease

Prepared by: Daniel Ryan M. Arriola II Ronald Dean A. Guerrero

Introduction
Pott disease, also known as tuberculous spondylitis or Davids Disease One of the oldest demonstrated diseases of humankind having been documented in spinal remains from the Iron Age and in ancient mummies from Egypt and the Pacific coast of South America.

Introduction Contd
In 1779, Sir John Percivall Pott, for whom the disease is named, presented the classic description of spinal tuberculosis.

Introduction Contd
Grave disorder that produces the destruction of the vertebrae Can cause inflammation of the bones and collapse of the vertebrae Resulting to compression of the spinal cord and nerve. (As shown in the animation.)

Introduction Contd
Usually occurring on the Kthoracic and vertebral region. The disease may occur in adulthood or childhood.

Introduction Contd
Since the advent of anti-tuberculous 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 nations.

Introduction Contd
Tuberculosis involvement of the spine has the potential to cause serious morbidity, including permanent neurologic deficits and severe deformities.

Introduction Contd
Medical treatment or combined medical and surgical strategies can control the disease in most patients.

VIDEO PRESENTATION: A GLIMPSE OF SPINE ANATOMY

(KINDLY FINISH THE VIDEO)

Anatomy & Function of the affected system

SPINAL COLUMN Made of 33 individual bones stacked one on top of the other. Ligaments and muscles connect the bones together and keep them aligned. Provides the main support for your body, allowing you to stand upright, bend, and twist. Protected deep inside the bones, the spinal cord connects your body to the brain, allowing movement of your arms and legs.

Anatomy & Function of the affected system Contd

Thoracic (mid back) Hold the rib cage Protect the heart and lungs

There are twelve thoracic vertebrae numbered T1 to T12.

The range of motion is limited.

Anatomy & Function of the affected system Contd

Intervertebral discs
Each vertebra in your spine is separated and cushioned by an intervertebral disc, It keeps the bones from rubbing together. Discs are designed like a radial car tire.

Anatomy & Function of the affected system Contd

Spinal Cord The spinal cord is about 18 inches long and is the thickness of your thumb. It runs within the protective spinal canal from the brainstem to the 1st lumbar vertebra. At the end of the spinal cord, the cord fibers separate into the cauda equina and continue down through the spinal canal to your tailbone before branching off to your legs and feet. Serves as an information super-highway, relaying messages between the brain and the body.

Anatomy & Function of the affected system Contd

Spinal Cord (continuation) Any damage to the spinal cord can result in a loss of sensory and motor function below the level of injury. An injury to the thoracic or lumbar area may cause motor and sensory loss of the legs and trunk (called paraplegia). An injury to the cervical (neck) area may cause sensory and motor loss of the arms and legs (called tetraplegia, formerly known as quadriplegia).

Causative Agent & Mode of transmission

Causative agents:
Mycobacteriun tuberculae

Mode of transmission:
Secondary to an extra spinal source of infection (Mycobacterium tuberculae) Inhalation of airborne droplets ( M. tuberculae) Hematogenous

Risk Factors
Close contact with people with active PTB Poor socioeconomics Malnutrition Immuno-compromised people Living in crowded area Health care workers Therapeutic immunosuppression African Americans, Hispanic Americans, Asian Americans

Signs and symptoms

Manifests as a combination of osteomyelitis and arthritis that usually involves more than 1 vertebra: Back pain Night sweats Weight loss Loss of appetite Fatigue and general malaise Pain and stiffness of the spine

Pathophysiology
POTTS DISEASE
(DAVIDS DISEASE/ TB OF THE BONE)

Risk Factor: Close contact with people with active PTB Poor socioeconomics Malnutrition Immuno-compromised people Living in crowded area Health care workers Therapeutic immunosuppression African Americans, Hispanic Americans, Asian Americans

Pathophysiology Contd
Mode of transmission: Inhalation of airborne droplets (Mycobacterium tuberculae)/Hematogenous The anterior aspect of the vertebral body adjacent to the subchondral plate is usually affected.

M.tuberculae spreads to adjacent interval disc between two (2) infected vertebrae

Pathophysiology Contd
Signs and Symptoms: Manifests as a combination of osteomyelitis and arthritis that usually involves more than 1 vertebra: 1. Back pain 4. Night sweats 2. Weight loss 5.Loss of appetite 3. Fatigue and general malaise 6. Pain and stiffness of the spine
Progressive bone destruction Vertebral collapse

Pathophysiology Contd
Kyphosis Pathognomonic Sign: (+) Gibbus formation Spinal canal can be narrowed by abscesses, granulation tissue or direct dural invasion

Spinal cord compression

Neurologic deficits Numbness and weakness of both lower extremities

Complication: Potts paraplegia

Diagnostic Examination
Blood test Skin test

Radiograph of the spine

CT-scan or spine MRI Acid-fast bacillus or culture and sensitivity testing

Medical Management
Non-operative Anti-TB drugs (Refampacin, Isoniazid, Pyrazinamide, Ethambutol, and Streptomycin) Immobilisation of the spine is usually for 2 or 3 months Taylor Brace Surgical
Drainage of abscess Anterior decompression with spinal fusion/Lumbar Spine Pedicle Screw Fixation Fusion

VIDEO PRESENTATION: LUMBAR SPINE PEDICLE SCREW FIXATION FUSION

(KINDLY FINISH THE VIDEO)

Nursing Care
Assess pain Assess ROM in all extremities Promote bed rest Advise and emphasize proper diet Advise increase fluid intake within cardiac limit Maintain skin integrity Patient education

Prognosis
Current treatment modalities are highly effective against Potts disease if the disorder is not complicated by severe deformity or established neurologic deficit. Deformity and motor deficit are the most serious consequences of Potts disease and continue to be a serious problem when diagnosis is delayed or presentation of the patient is in advanced stages of the disease.

Prognosis Contd
Therapy compliance and drug resistance are additional factors that significantly affect individual outcomes. Paraplegia resulting from cord compression caused by the active disease usually responds well to chemotherapy. However, paraplegia can manifest or persist during healing because of permanent spinal cord damage.

The End