Pott Disease (Spinal Tuberculosis)

Tuberculosis usually reaches the spine through the bloodstream from an infection elsewhere, most often the lungs. It characteristically settles in the front part of the vertebral bodies and gradually destroys them, often spreading beneath the ligaments to involve several adjacent levels while relatively sparing the discs early on. As the front of the spine collapses, the spine can angle sharply forwards, producing the characteristic sharp, angular hump known as a gibbus. The infection can also form a "cold" abscess — a collection of infected material that may track away from the spine, for example down into the psoas muscle of the abdomen. The lower thoracic and upper lumbar spine are most commonly affected.

The usual first symptom is back pain, often persistent and present at night, developing gradually over weeks to months. There may be general features of tuberculosis such as fever, night sweats, weight loss and tiredness, though these are not always present. As the disease advances, a visible deformity may develop. A particular concern is pressure on the spinal cord, which can cause weakness, numbness and difficulty walking — historically called Pott's paraplegia — and, if untreated, can lead to paralysis.

Persistent back pain over weeks to months, particularly with night pain, fever, night sweats, weight loss, or a developing deformity — and especially in someone from, or who has travelled to, a region where tuberculosis is common, or who has a weakened immune system — should be assessed. New weakness or numbness in the legs, difficulty walking, or loss of bladder or bowel control is a spinal emergency requiring immediate attention.

An MRI scan is the key imaging test and typically shows destruction of the front of the vertebrae, spread beneath the ligaments across several levels, and any abscess. Confirming the diagnosis, however, usually requires obtaining a sample — through an image-guided needle biopsy or at surgery — for tests that identify the tuberculosis bacterium, including modern molecular tests that can also detect drug resistance. Blood tests, chest imaging to look for lung tuberculosis, and inflammatory markers support the diagnosis. Establishing the diagnosis firmly, and identifying any drug resistance, is important because treatment is long and specific.

The mainstay of treatment is a prolonged course of combination anti-tuberculosis medication. This typically involves an intensive initial phase with several drugs together, followed by a longer continuation phase, with the total duration extending over many months and tailored to the response and to any drug resistance. Taking the full course exactly as prescribed is essential, both to cure the infection and to prevent drug-resistant tuberculosis. Nutritional support and management of any general effects of tuberculosis are also important.

Many people with Pott disease are cured with medication alone, sometimes combined with bracing. Surgery is considered in specific situations: pressure on the spinal cord causing neurological problems, significant or progressive spinal deformity, spinal instability, a large abscess, an uncertain diagnosis requiring tissue, or a failure to respond to medication. Where surgery is performed, it aims to drain infection, relieve pressure on the spinal cord, and stabilise and realign the spine, always alongside the full course of anti-tuberculosis drugs.

With early diagnosis and a complete, correctly taken course of anti-tuberculosis medication, the outlook is generally good, and many people recover well, including a good proportion of those who present with weakness, provided treatment begins promptly. Delay in diagnosis, established deformity, severe neurological injury before treatment, and drug-resistant tuberculosis all worsen the outlook. Because the deformity produced can be permanent, and because the treatment is long, early recognition and completing the full course are especially important.

Myth: "Tuberculosis only affects the lungs." Fact: Tuberculosis can affect the spine (Pott disease) and other bones and joints, as well as many other organs.

Myth: "A short course of antibiotics will clear it." Fact: Spinal tuberculosis requires a prolonged, specific course of combination anti-tuberculosis medication over many months.

Myth: "If there's weakness, paralysis is inevitable." Fact: Many people who present with weakness recover well when anti-tuberculosis treatment is started promptly.

This page is for general education and does not replace an individual assessment. Treatment depends on a person's specific symptoms, examination findings, imaging findings and overall health, and should always be discussed with a suitably qualified healthcare professional.

Pott disease, named after the surgeon Percivall Pott who described it in the eighteenth century, is tuberculosis (TB) of the spine. It is the commonest form of skeletal tuberculosis and remains an important cause of spinal disease worldwide, particularly where tuberculosis is common, but it is also seen elsewhere, including in people who acquired the infection abroad or who have a weakened immune system. Unlike ordinary bacterial spinal infection, which usually develops over days to weeks, tuberculosis of the spine tends to progress slowly over months, which is one reason it is often diagnosed late. This page explains how Pott disease affects the spine, how it is recognised and diagnosed, and how it is treated. It is closely related to our pages on discitis and vertebral osteomyelitis.

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• —Guideline note (place near references): World Health Organization tuberculosis treatment guidance informs the medical management principles. No dedicated NICE or AAOS clinical practice guideline specific to spinal tuberculosis surgery was identified at the time of writing; national tuberculosis programmes direct drug regimens.

This information is for general patient education and is not a substitute for an individual consultation. Always seek personalised advice from a qualified spinal specialist.