Historical aspects of Pott's disease (spinal tuberculosis) management

Abstract

Introduction: Spinal tuberculosis has existed in human beings since the ascent of man on earth. Historically, the management has progressed from regional orthodox therapies to the current, more effective, drugs.

Materials and methods: Historical perspectives regarding the management have been collated by going through the important publications during the past 6 decades. For convenience, the manuscript has been organized as "orthodox traditional" treatment, early "chemotherapy period", "post chemotherapy treatment", "middle-path" philosophy, and the current treatment with availability of modern imaging facilities.

Conclusions: Broad conclusions based upon the published data and personal observations (1959-2011) are summarized as follows: If diagnosis is made at predestructive stage and the patient is treated by standard drugs, the infection would heal in about 95 % patients without significant deformities and complications. Neural complications are still encountered in general hospital outpatients. Diagnosis and treatment at early stages would resolve the neurology without operation in about 40 % of cases. Nearly 60 % of patients would require to be operatively decompressed without jeopardizing mechanical stability. However, despite current treatment approximately 8 % of tuberculous paraplegics do not recover functionally. Immunocompromised state and multidrug resistance to standard drugs (8 to 10 %) are the current (and future) challenges to the doctors and the society.

Fig. 1

Note extensive tuberculous infection of the spine from dorsal 7 to lumbar L1 vertebrae

Fig. 2

PET scan of a patient who presented with an abscess in the right iliac foss. Note additional active lesions in the vertebral column

Fig. 3

Severe kyphotic deformity is unacceptable. Such deformities generally are a result of extensive vertebral body destruction, during childhood