PROGNOSIS Prognosis is variable. Some individuals will recover completely, particularly if the infection is treated promptly and aggressively.

Advanced disease may leave the individual with long-term disability even after the bacterial infection has been cured. Those requiring long-term suppressive therapy may develop recurrences if drug therapy is not maintained. Spinal fusion may be effective in relieving discomfort, depending on the severity of symptoms. Surgery will not, however, treat the underlying disease. In the past, prior to the discovery of drugs for TB that helped treat the disease, 20% of patients died and 30% had recurrences of their symptoms

Potts Disease MEDICAL MANAGEMENT Non Operative Treatment: - if detected early (before collapse of more than 1-2 vertebral body) treatment consists of antibiotics and immobilization; - even w/ mild kyphosis (but no neurologic deficit), antibiotics & non-operative - antituberculous drugs 1 CT scans and nuclear bone scans can also be used.Non-drugImmobilization of the spine is usually for 2 or 3 months.Therapy MRI is useful to demonstrate the extent of spinal compression and can show changes at an earlier stage than plain radiographs. Bone elements visible within the swelling, or abscesses, are strongly indicative of Potts disease as opposed to malignancy. Spinal x-ray may not show early disease as 50% of bone mass must be lost for changes to be visible on x-ray. However, plain radiographs can show vertebral destruction and narrowed disc space. bone biopsyImaging bone scan tuberculin skin test blood tests - elevated erythrocyte sedimentation rate bracing are used; - w/ adequate medical treatment, there may be significant resolution of neurologic symptoms, and there will be a halt in the progression of kyphosis; - in young children, there will often be some resolution in the kyphosis, especially if only one of two vertebrae are involved; - antibiotics for all patients at the outset, reserving surgery for cold abscesses that are palpable posteriorly, as well as for those cases w/ neurologicalenvironment that have failed to improve in response to 2-3 months of antiTB therapy and immobilization; - 2 months of pyrazinamide, isoniazid, and rifampin given qd, followed by 4 months of INH and rifampin; outcomes: - assessment of outcome should include prevalence of symptoms, amount of physical activity, amount of CNS involvement, presence/absence of sinusand/or abscess, and radiographic status of the lesion;Diagnostic Tests If debridement and fusion with bone grafting are NOT performed a minimum of 12 months treatment is required.P- atient should be reminded to attend check-ups at the nearestO-

rthopedic centerT- reatment should be taken in aT- imely mannerS- ight any symptoms other than the usual and report it to the physician If debridement and fusion with bone grafting are performed, treatment can be for six months Drug treatment is generally sufficient for Potts disease, with spinal immobilisation if required. Surgery is required if there is spinal deformity or neurological signs of spinal cord compression.Standard antituberculosis treatment is required.Duration of antituberculosis treatment: Acid-fast stain and culture for Mycobacterium tuberculosis, plus fungi and other pathogens, should be performed.Management of Potts disease Needle biopsy of bone or synovial tissue. Numbers of tubercle bacilli present are usually low but are pathognomonic. Austin Moore - intrameduallary rod (for Hemiarthroplasty)Microbiology Kuntcher Nail - intramedullary rod Richards intramedullary hip screw - facilitating for bone healing Surgery may be necessary, especially to drain spinal abscesses or to stabilize the spine immobilization of the spine region by rod (Hull) analgesics

PREVENTION Most cases of kyphosis cannot be prevented. The risk of osteoporosis and fractures of the spine can be lowered if a person has an adequate intake of calcium and regular weight-bearing exercise. Hormone replacement therapy can help prevent osteoporosis in perimenopausal women. Early treatment of tuberculosis can help prevent Pott's disease.

Laboratory with interpretation: Tuberculin skin test (Purified protein derivative PPD)demonstrates a positive finding in 84 to 95% of patients who are non HIV positive. Erythrocyte Sedimentation Rate (ESR) may be markedly elevated (>100 mm/h). Microbiology studies to confirm diagnosis: obtain bone tissue or abscess samples to stain for acid fast bacilli (AFB) and isolate organism for culture and susceptibility. These study findings may be positive in only about 50% of cases.

Imaging Studies: Plain radiography demonstrates the following characteristic changes of spinal tuberculosis: Lytic destruction of anterior portion of vertebral body. Increased anterior wedging. Collapse of vertebral body. Reactive sclerosis and a progressive lytic process. Enlarged psoas shadow with or without calcification. Additional Findings: Vertebral end plates are osteoporotic. Intervertebral disks may be shrunk or destroyed. Vertebral bodies show variables degrees of destruction. Fusiform paravertebral shadows suggests abscess formation. Bone lesions may occur more than one level. CT Scanning CT scanning provides much better bony detail of irregular lytic lesions, sclerosis, disk collapse, and disruption of bone circumference. Low-contrast resolution provides a better soft tissue assessment, particularly in epidural and paraspinal areas. It detects early lesions and is more effective for defining the shape and calcification of soft tissue abscesses. In contrast to pyogenic disease, calcification is common in tuberculosis lesions. MRI MRI is the criterion standard for evaluating disk space infection and osteomyelitis of the spine and is most effective in demonstrating the extension of disease into soft tissues and the spread of tuberculous debris under the anterior and posterior longitudinal ligaments. MRI is most effective for demonstrating neural compression.