Pathophysiology

Pott disease is usually secondary to an extraspinal source of infection. Pott disease manifests as a combination of osteomyelitis and arthritis that usually involves more than 1 vertebra. The anterior aspect of the vertebral body adjacent to the subchondral plate is usually affected. Tuberculosis may spread from that area to adjacent intervertebral disks. In adults, disk disease is secondary to the spread of infection from the vertebral body. In children, the disk, because it is vascularized, can be the primary site. [3] Progressive bone destruction leads to vertebral collapse and kyphosis. The spinal canal can be narrowed by abscesses, granulation tissue, or direct dural invasion, leading to spinal cord compression and neurologic deficits. The kyphotic deformity is caused by collapse in the anterior spine. Lesions in the thoracic spine are more likely to lead to kyphosis than those in the lumbar spine. A cold abscess can occur if the infection extends to adjacent ligaments and soft tissues. Abscesses in the lumbar region may descend down the sheath of the psoas to the femoral trigone region and eventually erode into the skin.

Prognosis
Current treatment modalities are highly effective against Pott disease if the disorder is not complicated by severe deformity or established neurologic deficit. Deformity and motor deficit are the most serious consequences of Pott disease and continue to be a serious problem when diagnosis is delayed or presentation of the patient is in advanced stages of the disease.[8] Therapy compliance and drug resistance are additional factors that significantly affect individual outcomes. Paraplegia resulting from cord compression caused by the active disease usually responds well to chemotherapy. However, paraplegia can manifest or persist during healing because of permanent spinal cord damage. Operative decompression can greatly increase the recovery rate, offering a means of treatment when medical therapy does not bring rapid improvement. Careful long-term follow up is also recommended, since late-onset complications can still occur (disease reactivation, late instability or deformity).[9]

Morbidity
Pott disease is the most dangerous form of musculoskeletal tuberculosis because it can cause bone destruction, deformity, and paraplegia. Pott disease most commonly involves the thoracic and lumbosacral spine. However, published series have shown some variation.[10, 11, 12, 13] The lower thoracic vertebrae make up the most common area of involvement (40-50%), followed closely by the lumbar spine (35-45%). In other series, proportions are similar but favor lumbar spine involvement.[14] Approximately 10% of Pott disease cases involve the cervical spine. The presentation of Pott disease depends on the following[15] : Stage of disease Affected site Presence of complications such as neurologic deficits, abscesses, or sinus tracts

Potential constitutional symptoms of Pott disease include fever and weight loss. The reported average duration of symptoms at diagnosis is 4 months[11] but can be considerably longer.[13, 16] This is due to the nonspecific presentation of chronic back pain. Back pain is the earliest and most common symptom of Pott disease, with patients usually experiencing this problem for weeks before seeking treatment. The pain caused by Pott disease can be spinal or radicular. Neurologic abnormalities occur in 50% of cases and can include spinal cord compression with paraplegia, paresis, impaired sensation, nerve root pain, and/orcauda equina syndrome. Cervical spine tuberculosis is a less common presentation but is potentially more serious because severe neurologic complications are more likely. This condition is characterized by pain and stiffness. Patients with lower cervical spine disease can present with dysphagia or stridor. Symptoms can also include torticollis, hoarseness, and neurologic deficits. The clinical presentation of spinal tuberculosis in patients infected with the human immunodeficiency virus (HIV) is similar to that of patients who are HIV negative; however, spinal tuberculosis seems to be more common in persons infected with HIV.[17] Source:

http://emedicine.medscape.com/article/226141-clinical