(Kiosk 3) Bilateral Lower Extremity Weakness Resulting from Tuberculous Associated Pott's Disease

Case Diagnosis: Pott's Disease

Case Description or Program Description: A 28-year-old male presented with chronic back pain, 50-pound weight loss over one year, and new onset lower extremity weakness.

Setting: Tertiary Care Center

Assessment/Results: CT and MRI demonstrated diffuse vertebral lytic osseous lesions with spinal canal and neural foraminal extension at multiple levels and severe T5 compression deformity. Sacral lesion biopsy demonstrated noncaseating granulomas, with no acid-fast bacilli. The patient was empirically started on RIPE therapy and discharged home. The patient was readmitted after one month with worsening bilateral lower extremity weakness and inability to ambulate. Repeat CT demonstrated worsening T5 compression deformity with retropulsion and moderate spinal canal stenosis. Urgent neurosurgical consultation resulted in T2-T7 spinal fusion and L4-L5 decompressive laminectomy. The patient was then transferred to acute inpatient rehabilitation for his neurological deficits including gait instability. The patient had marked improvement while working with physical and occupational therapy in the acute rehabilitation floor and upon discharge was able to ambulate independently without the use of an assistive device.

Discussion (relevance): Spinal tuberculosis, Pott’s Disease, is a rare but severe extrapulmonary manifestation of tuberculosis, affecting approximately 1% of all TB patients. Prompt recognition and treatment of Pott’s Disease are imperative to prevent neurological disability and spinal deformity. Patients with spinal tuberculosis and resulting neurologic deficits can show improvement with antitubercular treatment alone. However, urgent surgical intervention is required if the patient has new or worsening neurological deficits while on a trial of conservative treatment. Incomplete treatment can result in the complete collapse of one or more vertebral bodies resulting in short-segment structural kyphosis, referred to as Gibbus deformity. Progression of the disease can also result in paraplegia or quadriplegia.

Conclusions: Pott’s disease is a rare but significant cause of back pain. Progression of the disease can result in permanent neurological deficits if not promptly identified and appropriately treated.