Tuberculous spondylitis - Historically known as “Pott’s Disease”

Pott (or Pott’s) disease was named after Percivall Pott, who wrote several lectures on the nature and treatment of this condition.

The name “tuberculous spondylitis" comes from the disease tuberculosis, and the Greek "spondylos”, meaning spine, and “-itis”, meaning swelling. This is actually a form of chronic osteomyelitis, generally found in the lower thoracic or upper lumbar spine of adults. It’s also one of the oldest chronic conditions for which we have archaeological evidence.

Before tuberculosis had effective treatment modalities, this was one of the most common bone afflictions in adults. There were often internal abscesses that the infection drained into, which, while generally not the primary concern, could rupture and cause peritonitis or generalized infection of the thoracic cavity.

As the condition advanced, the degeneration of the bone often caused spinal cord compression and so-called “Pott’s paralysis" - a form of paraplegia that was actually reversible if the pressure was taken off the spinal cord soon after it started. This was usually done by stiff metal or (later) plastic braces or medical corsets. Once the infection advanced to the point that paralysis was caused, it often caused a complete collapse of the affected vertebrae, and could result in thoracic kyphosis, or “hunchback”.

The images above show a mummified priest of Ammon, from the XXIst dynasty (1000 BCE) of Egypt, with the characteristic lateral protrusion of the spine (left image) that hasn’t yet advanced to a collapse of the spinal discs. There is also a large sac in the abdomen (right image) that was soft when mummification occurred, and which would have been the abscess where the infection drained. There was evidence that the priest lived for over a decade with this condition, and it was probably not what killed him in the end.

Studies in the Paleopathology of Egypt. Sir Marc Armand Ruffer, 1921.

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    Interesting story above!!! Just 1% of pts with TBC develope Pott’s. Caseating granulomas Bone destruction....
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