Болезнь Потта: туберкулез позвоночника

Pott's disease, or Pott disease, named for British surgeon Percivall Pott who first described the symptoms in 1799, is tuberculosis of the spine, usually due to haematogenous spread from other sites, often the lungs. The lower thoracic and upper lumbar vertebrae areas of the spine are most often affected. It causes a kind of tuberculous arthritis of the intervertebral joints. The infection can spread from two adjacent vertebrae into the adjoining intervertebral disc space. If only one vertebra is affected, the disc is normal, but if two are involved, the disc, which is avascular, cannot receive nutrients, and collapses. In a process called caseous necrosis, the disc tissue dies, leading to vertebral narrowing and eventually to vertebral collapse and spinal damage. A dry soft tissue mass often forms and superinfection is rare. Spread of infection from the lumbar vertebrae to the psoas muscle, causing abscesses, is not uncommon.

Half of the cases of musculoskeletal tuberculosis are Pott's Disease, of which 98% affect the anterior column. The disease can be attributed to 1.3 million deaths per year. There is a correlation between tuberculosis infections and cases of Pott's disease, as it's prevalent in areas where tuberculosis infections are common Factors like socioeconomic status, habits, medical history, and interactions with people with tuberculosis can influence the rate of diagnosis. Underdeveloped countries have a higher incidence rate of Pott's disease as it's associated with less ventilated rooms, crowded spaces, poorer hygiene, and less access to healthcare facilities. Increasing food security, reducing poverty, and improving living and working conditions will help to prevent infection and generally enhance the care of those sick. Pott's disease is more common in the working age population. It is becoming increasingly prevalent in older adults due to increased life expectancies, increased immunosuppressant use, chronic diseases like diabetes, and a rise in drug resistant tuberculosis strains. In older populations, the disease is often misdiagnosed, often being disregarded for other degenerative diseases. Children's spines contain more cartilage, increasing the effect of spinal deformations caused by the disease. Multidrug resistant tuberculosis poses a threat to people with Pott's disease, making it difficult to determine infection in people because of the paucibacillary symptoms of the disease. Cases of tuberculosis have been on the decline; however, infections of multidrug resistant tuberculosis have remained constant since the 1990s.

Max Blecher's semi autobiographical novel Inimi cicatrizate (1937) is about a young man named Emanuel who is afflicted with Pott disease in a sanatorium, as is the Radu Jude film Scarred Hearts (2016), loosely based on it. A. J. Cronin's story "Two Gentlemen of Verona," includes a character named Lucia with tuberculosis of spine. In William Golding's novel The Spire (1964), Jocelin, the dean who wanted a spire on his cathedral, probably dies as a result of the disease. Katharine Butler Hathaway's memoir The Little Locksmith (1943) is about the effects of spinal tuberculosis on her childhood and adult life. In Victor Hugo's Hunchback of Notre Dame (1831) the title character has a gibbus deformity similar to the type caused by spinal tuberculosis. In Henrik Ibsen's play A Doll's House (1879), Dr. Rank has "consumption of the spine." In Sergio Leone's film Once Upon a Time in the West (1968), Morton, the railroad magnate, has the disease and needs crutches to walk. In Ernest Poole's Pulitzer Prize winning novel, His Family (1917), young Johnny Geer has a terminal case of Pott disease. In Edmund Wilson's Memoirs of Hecate County (1946), the novella "The Princess with the Golden Hair," has a character with Pott disease.