Which physical findings are characteristic of Pott disease (tuberculous [TB] spondylitis)?

Updated: Aug 08, 2019
  • Author: Jose A Hidalgo, MD; Chief Editor: John L Brusch, MD, FACP  more...
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Answer

Although the thoracic and lumbar spinal segments are nearly equally affected in persons with Pott disease, the thoracic spine is frequently reported as the most common site of involvement. Together, these segments make up 80-90% of spinal tuberculosis sites, with the remaining cases of Pott disease occurring in the cervical spine. [19, 20, 22] Almost all patients with Pott disease have some degree of spine deformity (kyphosis).

Examination should reveal local pain related to the affected area or radicular pain. Muscle spasm and rigidity can also be associated.

Large, cold abscesses of paraspinal tissues or psoas muscle may protrude under the inguinal ligament and may erode into the perineum or gluteal area.

Neurologic deficits may occur early in the course of Pott disease. Signs of such deficits depend on the level of spinal cord or nerve root compression.

Pott disease that involves the upper cervical spine can cause rapidly progressive symptoms. Retropharyngeal abscesses occur in almost all cases affecting this part of the spine. Neurologic manifestations occur early and range from a single nerve palsy to hemiparesis or quadriplegia.

A large proportion of patients with Pott disease do not present with extraskeletal disease. In reported series, only 10-38% of cases of Pott disease are associated with extraskeletal tuberculosis.


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