Pott�s Disease (Spinal Tuberculosis) and Occupational Therapy Management
Pott disease or spinal tuberculosis is a form of tuberculosis that occurs outside the lungs whereby disease is seen in the vertebrae. Tuberculosis can affect several tissues outside of the lungs including the spine, a kind of tuberculous arthritis of the intervertebral joints. The disease is named after Percivall Pott (17141788), a British surgeon.
The lower thoracic and upper lumbar vertebrae are the areas of the spine most often affected. The formal name for the disease is tuberculous spondylitis and it is most commonly localized in the thoracic portion of the spine.
Epidemiology
Potts disease is rare in the UK but in developing countries it represents about 50% of musculoskeletal tuberculosis.
Tuberculosis worldwide accounts for 1.7 billion infections, and 2 million deaths per year.
Over 90% of tuberculosis occurs in poorer countries, but a global resurgence is affecting richer ones.
India, China, Indonesia, Pakistan and Bangladesh have the largest number of cases but there has been a marked increase in the number of cases in the former Soviet Union and in sub-Saharan Africa in parallel with the spread of HIV.
About two thirds of affected patients in developed countries are immigrants
Types of Potts Disease or Spinal Tuberculosis
There are two main types of Pott Disease or Spinal Tuberculosis. One is the classic form of Spinal Tuberculosis also called as spondylo-discitis and the other is quite a common form that is spondylitis without disc involvement.
Symptoms
Malaise
Weight loss
Appetite loss
Night sweats
Fever, usually in the evening hours
Stiff and painful spine, especially with movement
Paraspinal muscle spasms
Multidisciplinary Team (MDT)
A group of health care professionals works for the improvement of Potts disease. These are:
Infectious Disease Internist
Neurologist
Neurosurgeon
Occupational Therapist
Orthopedic (Orthopaedic) Surgeon
Physiatrist (Physical Medicine and Rehabilitation Specialist)
Occupational Therapy Management
Many individuals with Potts disease present with spinal instability, vertebral collapse, and progressive neurological signs that may ultimately require spinal surgery (spinal fusion). Rehabilitation for individuals following spinal fusion will depend on the type of instrumentation used, the preoperative status of the individual, and the number of spinal segments fused.
Care must be taken to protect the fusion site until diagnostic tests reveal that fusion has fully occurred. The goals of Occupational Therapists are for the individual to achieve independent mobility and self care with activities of daily living (ADLs).
Occupational therapists provide following treatment during
therapy session:
Advice about proper bed
mobility
Postural education
Transfer techniques (e.g. bed to wheelchair or wheelchair to bed, chair to chair, chair to different shape of box etc.)
Advice about bowel and bladder management
Caregiver and patient education about pressure care prevention
ADLs training (feeding, grooming, bathing,)
Advice adaptive equipments or assistive devices if necessary
Ergonomic assessment of the workplace which indicated to facilitate return to work.
Prognosis
Early diagnosis is always recommended for motor deficit and deformity in Potts disease is extremely grave effect.
Serious problems may be presented if the diagnosis gets delayed or the patient sees the doctor when the condition has progressed to the advanced stages.
Doctors may predict the development of the condition according to symptoms. If Potts disease makes cord compression and finally results in paraplegia, patient may respond quite well to the chemotherapy.
However, permanent destruction of the spinal cord can result in paraplegia that can interfere with the healing process.
If medications do not help much, operative decompression may offer an alternative treatment.
