| Pott’s disease is a presentation of extrapulmonary
tuberculosis that affects the spine, a kind of tuberculous arthritis
of the intervertebral joints. Scientifically, it is called tuberculous
spondylitis. Pott’s 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 Pott’s 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.
Pott’s 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 Pott’s curvature. In some cases,
a person with Pott's disease may also develop paralysis, referred
to as Pott’s paraplegia, when the spinal nerves become affected
by the curvature.
ETIOLOGY of Pott's Disease
• Causative organism: Mycobacterium tuberculosis.
• Spread: Haematogenous. (by blood)
• Commonly associated with: Debilitating diseases, AIDS, Drug
addiction, Alcoholism.
CLINICAL FEATURES of Tuberculosis of Spine
Symptoms
The onset is gradual.
• Back pain is localised.
• Restricted spinal movements.
• Fever.
• Night sweats.
• Anorexia.
• Weight loss.
Signs
• There may be kyphosis. (spinal curvature)
• Muscle wasting.
• A paravertebral swelling may be seen.
• They tend to assume a protective upright, stiff position.
• If there is neural involvement there will be neurological
signs.
• A psoas abscess (may present as a lump in the groin and
resemble a hernia).
Differential diagnosis
• Pyogenic osteitis of the spine.
• Spinal tumours.
INVESTIGATION for Pott's Disease
Blood
• TLC: Leucocytosis.
• ESR: raised during acute stage.
Tuberculin skin test
• Strongly positive.
• Negative test does not exclude diagnosis.
Aspirate from joint space & abscess
• Transparency: turbid.
• Colour: creamy.
• Consistency: cheesy.
• Fibrin clot: large.
• Mucin clot: poor.
• WBC: 25000/cc.mm.
Histology
• Shows granulomatous tubercle.
X-Ray spine
Early:-
• Narrowed joint space.
• Diffuse vertebral osteoporosis adjacent to joint.
• Erosion of bone.
• Fusiform paraspinal shadow of abscess in soft tissue.
Late:-
• Destruction of bone.
• Wedge-shaped deformity (collapse of vertebrae anteriorly).
• Bony ankylosis.
Complications
• Vertebral collapse resulting in kyphosis.
• Spinal cord compression.
• Sinus formation.
• Paraplegia (so called Pott's paraplegia).
GENERAL MANAGEMENT for Pott's Disease
• Bed rest.
• Immobilisation of affected joint by splintage.
• Nutritious, high protein diet.
• Drainage of abscess.
• Surgical decompression.
• Physiotherapy.
Homeopathic Treatment for Pott's Disease / Spinal Tuberculosis
Homeopathy treats the person as a whole. It means that homeopathic
treatment focuses on the patient as a person, as well as his pathological
condition. The homeopathic medicines are selected after a full individualizing
examination and case-analysis, which includes the medical history
of the patient, physical and mental constitution etc. A miasmatic
tendency (predisposition/susceptibility) is also often taken into
account for the treatment of chronic conditions. The medicines given
below indicate the therapeutic affinity but this is not a complete
and definite guide to the treatment of this condition. The symptoms
listed against each medicine may not be directly related to this
disease because in homeopathy general symptoms and constitutional
indications are also taken into account for selecting a remedy.
To study any of the following remedies in more detail, please visit
our Materia Medica
section. None of these medicines should be taken without professional
advice.
Homeopathic Remedies
Calc carb.
Pain as if sprained; can scarcely rise; from overlifting. Pain
between shoulder-blades, impeding breathing. Rheumatism in lumbar
region; weakness in small of back. Curvature of dorsal vertebrae.
Nape of neck stiff and rigid.
Calc carb suits to person with Leucophlegmatic constitution, blond
hair, light complexion, blue eyes, fair skin; tendency to obesity
in youth. Psoric constitutions; pale, weak, timid, easily tired
when walking. Disposed to grow fat, corpulent, unwieldy. Children
with red face, flabby muscles, who sweat easily and take cold readily
in consequence. Large heads and abdomens; fontanelles and sutures
open; bones soft, develop very slowly. Curvature of bones, especially
spine and long bones; extremities crooked, deformed; bones irregularly
developed. Head sweats profusely while sleeping,
Calc phos.
Rheumatic pain and stiffness of neck with dulness of head, from
slight drought of air. Cramp-like pain in neck first one side then
the other (right to left). Throbbing or jerking pains below scapula.
Violent pain in region of back when making the least effort. Backache
and uterine pains. Sharp pains in sacrum and coccyx. Soreness as
if separate in sacro-illiac synchondrosis. Curvature of the spine
to the left, lumbar vertebrae bend to the left, spina bifida. Soreness
in sacro-iliac symphysis, as if broken.
Calc phos suits to person with anaemic and dark complexion, dark
hair and eyes; thin spare subjects, instead of fat.
Phos acid.
Tension and cramp-like drawing in muscles of neck, especially on
moving head. Miliaria on neck. Boring pain between scapulae. Spondylitis
of cervical vertebrae.
Eruption, painful to touch, on back, shoulder-blades, neck, and
chest. Burning pain in a spot above small of back. Itching stitch
in coccyx, fine stitches in coccyx and sternum. Crawling (formication)
tingling in back and loins.
Phos acid best suited to persons of originally strong constitutions,
who have become debilitated by loss of vital fluids.
Phosphorus.
Rigidity of nape of neck. Pressure on shoulders. Swelling of neck.
Engorgement of axillary glands and of those of nape of neck and
of neck. Paralysed sensation in upper sacrum and lower lumbar vertebrae.
Contusive pain in loins and back (as if back were broken), especially
after having been seated a long time, hindering walking, rising
up, or making the least movement. Pain in small of the back when
rising from a stooping position. Sensitiveness of spinous processes
of dorsal vertebrae to pressure. Softening of spine. Heat or burning
in back, between scapula. Tearings and stitches in and beneath both
scapula. Pain in coccyx impeding easy motion, can find no comfortable
position, followed by painful stiffness of nape. Coccyx painful
to touch as from an ulcer. Transient pain from coccyx though spine
to vertex that drew head back during the stool. Backache and palpitations
prevail.
Phos best adapted to tall slender persons of sanguine temperament,
fair skin, eyelashes, fine blond, or red hair, quick perceptions,
and very sensitive nature. Young people who grow too rapidly are
inclined to stoop who are chlorotic or anaemic; old people, with
morning diarrhoea. Nervous, weak; desires to be magnetized Oversensitiveness
of all the senses to external impressions, light, noise, odors,
touch. Restless, fidgety; moves continually, cannot sit or stand
still a moment Burning: in spots along the spine; between the scapulae;
or intense heat running up the back;of palms of hands in chest and
lungs; of every
organ or tissue of the body generally in diseases of nervous system.
Haemorrhage diathesis; small wounds bleed profusely.
Silicea.
Stiffness of nape, with headache. Swelling of glands of nape, in
the neck, and under the axillae (with suppuration), sometimes with
induration. Suppuration of axillary glands. Caries of clavicle.Stitches
between the hips.Coccyx painful, as after a long carriage ride.-
Stinging in os coccyges on rising, painful to pressure. -Scabby
elevation on coccyx, above fissure of nates.- Pain in the loins,
which prevents rising up, and forces patient to remain lying down.-
Inflammatory abscess in lumbar region (on the psoas muscle).- Weakness
and paralytic stiffness in back, loins, and nape.- Tearings and
shootings in the back.- Shootings in the loins, when seated or lying
down.-Burning in back when walking in open air and becoming warm.-
Aching, shooting, burning, and throbbing in lumbo-sacral region.-
Swelling and distortion of spine (curvature of the vertebrae).-Contusive
pain between the shoulder-blades.
Silicea best adapted to the nervous, irritable, sanguine temperament;
persons of a psoric diathesis. Persons of light complexion; fine
dry skin; pale face; weakly, with lax muscles. Constitutions which
suffer from deficient nutrition, not because food is lacking in
quality or quantity, but from imperfect assimilation. Oversensitive,
physically and mentally. Scrofulous, rachitic children with large
heads; open fontanelles and sutures; much sweating about the head.
Sulphur.
Stiffness of neck, in nape, with paralytic, sprained pain. Child
cannot hold head up neck muscles so weak. Tetters on nape. Swelling
and inflammation of glands of nape and of neck.Swelling and suppuration
of axillary glands. Cracking in vertebrae of neck, especially on
bending backwards. Weakness and wrenching pains, or pain as from
a bruise in loins, coccyx, and in back, especially on walking, or
rising from a seat. Gnawing pain in small of back. Pain in small
of back not permitting one to stand erect. Finds himself at night
lying on back. Cannot lie on back on account of rush of blood to
head. Pain in back after manual labour. Shootings in loins, back,
and shoulder-blades, sometimes with obstructed respiration. Sharp
and rheumatic pains, drawing, tension, and stiffness in loins, back,and
nape. Pinching and burning sensation between the shoulder-blades.
Tension and bruised pain between scapulae and in nape, which on
moving head goes to shoulders. Stitches beneath scapulae which take
away the breath. Drawing in right scapula, evening on going to sleep.
Tearing in left scapula while sitting. Needle-shoots at point of
left scapula. Sprained pains in back. During whole day aching in
small of back, worse when urinating.Distortion (curvature) of spine.
Vertebrae softened. Cracking of vertebrae on bending head backward.
Sulphur Adapted to persons of a scrofulous diathesis, subject to
venous congestion; especially of portal system. Persons of nervous
temperament, quick motioned, quick tempered, plethoric, skin excessively
sensitive to atmospheric changes. For lean, stoop-shouldered persons
who walk and sit stooping like old men. Standing is the worst position
for sulphur patients; they cannot stand; every standing position
is uncomfortable. Dirty, filthy people, prone to skin affections.
Aversion to being washed; always <. after a bath.
Symphytum.
Pain in back from a fall, from sexual excess. Pott's disease after
injury. Psoas abscess. Much used among herbalists in caries of spinal
and other bones.
Symphytum facilitates union of fractured bones; lessens peculiar
pricking pain; favors production of callous; when trouble is of
nervous origin. Irritability at point of fracture; periosteal pains
after wounds have healed.
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