Malik Muhammad Khalid, Maratib Ali, Masoom Raza Mirza And Ata-ur-rehman.
Management of Pott’s disease experience at tertiary care hospital.
J Pak Orthop Assoc Jan ;22(1):28-34.

OBJECTIVE: To evaluate the management of Pott’s disease by Anti Tuberculous Chemotherapy and by surgery in cases of failure of conservative management and complications. STUDY DESIGN: Prospective descriptive study. PLACE AND DURATION OF STUDY: From January 1998 to December 2008 at Orthopaedics unit II of Civil Hospital, Karachi. PATIENTS & METHODS: We conducted our study in three stages. In 1st stage all patients who attended out patient department with history of backache, weight loss and low grade fever of more than six weeks duration were recruited (n==185). In 2nd stage (133 patients) who had positive findings on investigations along with clinical assessment of having tuberculosis were included in this stage and Anti tuberculous treatment (ATT) with minimum of four drugs was started. In 3rd stage patients were followed up regularly for any adverse effects of chemotherapy and progress of disease. Those patients who completed minimum of 6 months of ATT (78 patients) were included in this stage. RESULTS: After Exclusion 78 patients finally entered in stage 3. There were 47 (60.3%) female and 31 (39.7%) male patients who completed the study. Majority of patients were in their fourth decade of life. Backache was the commonest symptom, followed by constitutional symptoms. Paraplegia was present in 20 patients in stage 1, 14 in stage 2 and 11 in stage 3. Majority of patients, 80% were registered with us when symptoms were more than six months. Plain radiograph of spine was suggestive of disease in 39 (29.32%) and very suggestive in 83 (62.40%) of patients. Lumber spine was the most frequently involved site in 45 (34%) of cases. All the patients who entered in stage 2 were started with ATT. A total of 52 patients were operated in stage 2, eight patients were dropped in stage 3, three patients expired and five patients were lost to follow up. Out of 44 patients operated who were followed in stage 3, diagnosis was confirmed on histopathological examination in 38 (86.4%) of cases. The over all fusion rates was good (more than 80%). Post operative complications were seen in 12 (23.07%) patients. CONCLUSION: Anti tuberculosis, spine, Pott’s disease. Conservative, chemotherapy, backache, paraplegia, kyphoscoliosis, abscess, decompression

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