DEFINITION POTTS DISEASE Potts disease also known as tuberculous spondylitis is a presentation of extra pulmonary tuberculosis that affects

the spine, a kind of tuberculous arthritis of the intervertebral joints. Scientifically, it is called tuberculous spondylitis. Potts disease is the most common site of bone infection in TB; hips and knees are also often affected. The lower thoracic and upper lumbar vertebrae are the areas of the spine most often affected. Pott's disease, which is also known as Potts caries, David's disease, and Pott's curvature, is a medical condition of the spine. Individuals suffering from Pott's disease typically experience back pain, night sweats, fever, weight loss, and anorexia. They may also develop a spinal mass, which results in tingling, numbness, or a general feeling of weakness in the leg muscles. Often, the pain associated with Pott's disease causes the sufferer to walk in an upright and stiff position. Potts disease is caused when the vertebrae become soft and collapse as the result of caries or osteitis. Typically, this is caused by mycobacterium tuberculosis. As a result, a person with Pott's disease often develops kyphosis, which results in a hunchback. This is often referred to as Potts curvature. In some cases, a person with Pott's disease may also develop paralysis, referred to as Potts paraplegia, when the spinal nerves become affected by the curvature. The disease progresses slowly. Signs and symptoms include: back pain, fever, night sweats, anorexia, weight loss, and easy fatigability. Diagnosis is based on: blood tests - elevated ESR, skin tests, radiographs of the spine , bone scan, CT of the spine , and bone biopsy. Gibbus formation is the pathognomonic sign of this disease. Gibbus formation refers to a sharply angled curvature of the backbone, resulting from collapse of a vertebra or simply a hunchback. Approximately 1-2% of total tuberculosis cases are attributable to Pottdisease. The incidence rate here in the Philippines is approximately 20-30% of all the patient diagnosed to have Tuberculosis. Most of the cases of the Pott's disease in the Philippines is caused by the noncompliance of the treatment regimen of TB. Internationally, between 1993 and 2001, tuberculosis of the bone and joints accounted for 3.5% of all tuberculosis cases (0.2-1.1% in patients of European origin and 2.3-6.3% in patients of non-European origin. 21 nursing problems according to Faye Glenn Abdellah could be best adapted on this kind of case. She defined nursing as broadly grouped into the 21nursing problem areas to guide care and promote the use of nursing judgment. She also said that nursing is a service that is based on the art and science and aims to help people, sick or well, cope with their health needs. The said disease could lead to different problems that the patients can experience. It is the responsibility of the nurse to meet the different needs of the client to achieve the optimum level of functioning. The researcher chose to discuss Pott's disease as one of the requirement in the rotation. This study will help the researcher to analyze and dig deeper and see a clearer picture, in response to our roles as future registered nurses. ANATOMY AND PHYSIOLOGY The spinal cord is the largest nerve in the body, and it is comprised of the nerves which act as the communication system for the body. The nerve fibers within the spinal cord carry messages to and from the brain to other parts of the body. The spinal cord is surrounded by protective bone segments, called the vertebral column. The vertebral column is comprised of seven cervical vertebrae, twelve thoracic vertebrae, five lumbar vertebrae and five sacral vertebrae. The vertebral column also provides attachment points for muscles of the back and ribs. The vertebral disks serve as shock absorbers during activities such as walking, running and jumping, they also allow the spine to flex and extend. DIAGNOSTIC PROCEDURES 1. TUBERCULINE SKIN TEST (Purified Protein Derivative [PPD]) Results are positive in 84-95% of patients with Potts disease who are not infected with HIV. A standard dose of 5 Tuberculin units (0.1 mL) (The standard Mantoux test in the UK consists of an intradermal injection of 2TU of Statens Serum Institute (SSI) tuberculin RT23 in 0.1ml solution for injection.) Injected intradermally (between the layers of dermis) and read 48 to 72 hours later. This intradermal injection is termed the mantoux technique. A person who has been exposed to the bacteria is expected to mount an immune response in the skin containing the bacterial proteins. The reaction is read by measuring the diameter of in duration (palpable raised hardened area) across the forearm (perpendicular to the long axis) in millimeters. If there is no in duration, the result should be recorded as "0 mm". Erythema (redness) should not be measured. If a person has had a history of a positive tuberculin skin test, or has not had a recent tuberculin skin test (within one year), another skin test may be needed. 2. THE ERYTHROCYTE SEDIMENTATION RATE (ESR) may be markedly elevated (>100mm/h) ESR stands for erythrocyte sedimentation rate. It is a test that indirectly measures show much inflammation is in the body. However, it rarely leads directly to a specific diagnosis. This test can be used to monitor inflammatory or cancerous diseases. It is a screening test, which means it cannot be used to diagnose a specific disorder. However, it is useful in detecting and monitoring tuberculosis, tissue death, and certain forms of arthritis, autoimmune disorders, and inflammatory diseases that cause vague symptoms. 3. RADIOGRAPHY Radiographic changes associated with Pott disease present relatively late. The following are radiographic changes characteristic of spinal tuberculosis on plain radiography: visibly seen curvature of the spine or visible bone lesions on different levels.

4. CT SCANNING CT scanning provides much better bony detail of irregular lytic lesions, sclerosis, disk collapse, and disruption of bone circumference. Lowcontrast resolution provides a better assessment of soft tissue, particularly in epidural and paraspinalareas. CT scanning reveals early lesions and is more effective for defining the shape and calcification of soft-tissue abscesses. In contrast to pyogenic disease, calcification is common in tuberculous lesions. 5. MRI MRI is the criterion standard for evaluating disk-space infection and osteomyelitis of the spine and is most effective for demonstrating the extension of disease into soft tissues and the spread of tuberculous debris under the anterior and posterior longitudinal ligaments. MRI is also the most effective imaging study for demonstrating neural compression.MRI findings useful to differentiate tuberculous spondylitis from pyogenic spondylitis include thin and smooth enhancement of the abscess wall and well-defined paraspinal abnormal signal, whereas thick and irregular enhancement of abscess wall and ill-defined paraspinal abnormal signal suggest pyogenic spondylitis. Thus, contrast-enhanced MRI appears to be important in the differentiation of these two types of spondylitis. 6. BONE BIOPSY A bone biopsy is a procedure in which a small sample of bone is taken from the body and looked at under a microscope for cancer, infection, or other bone disorders. Confirm the diagnosis of a bone disorder that was found by another test, such as an X-ray, CT scan, bone scan, or a MRI. Tell the difference between a noncancerous (benign) bone mass, such as a bone cyst, and bone cancer, such as multiple myeloma. See what is causing a bone infection (osteomyelitis) or if an infection is present. Find the cause of ongoing bone pain. Check bone problems seen on an X-ray. MEDICAL-SURGICAL-NURSING MANAGEMENT Since Pott's disease is caused by a bacterial infection, prevention is possible through proper control. The best method for preventing the disease is reduced or eliminates the spread of tuberculosis. In addition, testing for tuberculosis is an important preventative measure, as those who are positive for purified protein derivative (PPD) can take medication to prevent tuberculosis from forming. A tuberculin skin test is the most common method used to screen for tuberculosis, though blood tests, bone scans, bone biopsies, and radiographs may also be used to confirm the disease. MEDICAL MANAGEMENT Before the advent of effective antituberculosis chemotherapy, Pott disease was treated with immobilization using prolonged bed rest or a body cast. Studies performed by the British Medical Research Council indicate that tuberculous spondylitis of the thoracolumbar spine should be treated with combination chemotherapy for 6-9 months. According to the most recent recommendations issued in 2003 by the US Centers for Disease Control and Prevention, the Infectious Diseases Society of America, and the American Thoracic Society, a 4-drug regimen should be used empirically to treat Pott disease. Isoniazid and rifampin should be administered during the whole course of therapy. Additional drugs are administered during the first 2 months of therapy. These are generally chosen among the first-line drugs, which include pyrazinamide, ethambutol, and streptomycin. The use of second-line drugs is indicated in cases of drug resistance. Opinions differ regarding whether the treatment of choice should be conservative chemotherapy or a combination of chemotherapy and surgery. The treatment decision should be individualized for each patient. SDURGICAL MANAGEMENT Indications for surgical treatment of Pott disease generally include the following: Neurologic deficit (acute neurologic deterioration, paraparesis, paraplegia) Spinal deformity with instability or pain No response to medical therapy (continuing progression of kyphosis or instability) Large paraspinal abscess Non diagnostic percutaneous needle biopsy sample Resources and experience are key factors in the decision to use a surgical approach. The lesion site, extent of vertebral destruction, and presence of cord compression or spinal deformity determine the specific operative approach (kyphosis, paraplegia, tuberculous abscess).

 In Pott disease that involves the cervical spine, the following factors justify early surgical intervention: High frequency and severity of neurologic deficits Severe abscess compression that may induce dysphagia or asphyxia Instability of the cervical spine NURSING DIAGNOSIS Acute pain related to inflammatory process Disturbed body image related to trauma/injury to spinal cord Self bathing hygiene deficit related to musculoskeletal impairment Impaired physical mobility related to therapeutic restriction of movement Imbalance nutrition related to inadequate food intake

NURSING RESPONSIBILITIES Drug treatment is generally sufficient for Potts disease, with spinal immobilization if required. Surgery is required if there is spinal deformity or neurological signs of spinal cord compression. Standard antituberculosis treatment is required. Duration of antituberculosis treatment: If debridement and fusion with bone grafting are performed, treatment can be for six months. If debridement and fusion with bone grafting are NOT performed a minimum of 12 months treatment is required. It may also be necessary to immobilize the area of the spine affected by the disease, or the person may need to undergo surgery in order to drain any abscesses that may have formed or to stabilize the spine. Other interventions include application of knight/ Taylor brace, head halter traction. PATIENTS HEALTH TEACHING P- atient should be reminded to attend check-ups at the nearest. O- rthopedic center T- reatment should be taken in a.. T- imely manner S- ight any symptoms other than the usual and report it to the physician.

CASE STUDY POTTS DISEASE (TUBERCULOUS SPONDYLITIS)