A 39-Year-Old Man With Debilitating Back Pain

Tami O. Tiamfook-Morgan, MD; Daniel M. Lindberg, MD

Disclosures

April 27, 2016

Treatment of Pott disease consists of at least a three-drug and, frequently, a four-drug regimen of antituberculous medications. A 6-month course of therapy is recommended for tuberculosis involving all sites (except the meninges) by the American Thoracic Society, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America.[7]

In one study, routine surgery was not shown to be beneficial for the treatment of Pott disease;[8] however, if used judiciously, surgery may improve early mobilization and reduce mortality.[9] Surgery is more clearly indicated for decompression of the spinal cord if the patient has advanced neurologic deficits or neurologic deficits that progress or persist despite medical therapy, if the patient's spinal stability is a concern (with kyphosis greater than 40°), or if an epidural abscess needs to be drained.

After treatment, patients should be closely followed for their response to therapy and medication compliance, because these issues can significantly affect their individual outcomes.

The patient in this case was admitted to the hospital, where he underwent diskectomies of T10 to L1, corpectomy of T11 and T12, drainage of the epidural abscess, and fusion of T11 and T12. He was definitively diagnosed with tuberculous spondylitis (Pott disease) after cultures revealed pansusceptible M tuberculosis. He was discharged to home with a 9-month course of rifampin, isoniazid, pyridoxine, and pyrazinamide. He was able to ambulate at the time of discharge.

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