GENERAL MANAGEMENT for Pott's Disease

• Bed rest.• Immobilisation of affected joint by splintage.• Nutritious, high protein diet.• Drainage of abscess.• Surgical decompression.• Physiotherapy.

MANAGEMENT

Drug treatment is generally sufficient for Pott’s disease, with spinal immobilization if required. Surgery is required if there is spinal deformity or neurological signs of spinal cord compression. Standard anti-tuberculosis treatment is required. Duration of antituberculosis treatment: If debridement and fusion with bone grafting are performed, treatment can be for six months. If debridement and fusion with bone grafting are NOT performed within minimum of 12 months’ treatment is required.

It may also be necessary to immobilize the area of the spine affected by the disease, or the person may need to undergo surgery in order to drain any abscesses that may have formed or to stabilize the spine.

SURGICAL MANAGEMENT

o Indications for surgical treatment of Pott disease generally include the following:

Neurologic deficit (acute neurologic deterioration, paraparesis, paraplegia)

Spinal deformity with instability or pain

No response to medical therapy (continuing progression of kyphosis or instability)

Large paraspinal abscess

Nondiagnostic percutaneous needle biopsy sample

The lesion site, extent of vertebral destruction, and presence of cord compression or spinal deformity determine the specific operative approach (kyphosis, paraplegia, tuberculous abscess).

Vertebral damage is considered significant if more than 50% of the vertebral body is collapsed or destroyed or a spinal deformity of more than 5° exists. The most conventional approaches include anterior radical focal debridement and posterior stabilization with instrumentation.

In Pott disease that involves the cervical spine, the following factors justify early surgical intervention:o High frequency and severity of neurologic deficitso Severe abscess compression that may induce dysphagia or asphyxia

o Instability of the cervical spine

ANTERIOR DECOMPRESSION SPINAL FUSION

The spine fusion procedure begins with either a longitudinal or transverse incision in the lower front of the neck. The underlying musculature of the neck is carefully dissected, allowing the surgeon to expose the anterior cervical spine by retracting the esophagus and trachea toward midline and the carotid artery and associated structures laterally.

Muscles and membranes overlying the anterior cervical spine are dissected as well, and retractors are placed to protect the soft tissues of the neck as the operation proceeds.

the spine surgeon will recommend internal fixation of the operated/grafted segments with a titanium plate and screw device, which is secured to the remaining vertebral bodies at the margins of the corpectomy, providing for further stability and promoting adequate fusion as well as preventing dislodgement of the bone graft