Conditions · Spine

Spinal tuberculosis (Pott disease) !

Spinal tuberculosis (Pott disease) is a tuberculosis infection of the vertebrae and discs; it causes slowly worsening back pain and can deform the spine.

Updated 2026-10-29

Structures involved

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Microorganisms that cause it

Mycobacterium tuberculosis

Why it happens

What it is

Infection of the vertebrae and discs by Mycobacterium tuberculosis, usually spread through the blood from another focus. It is the most common form of bone and joint tuberculosis.

Who gets it

Seen mostly where tuberculosis is common, including Colombia and other parts of Latin America, and in people with HIV. It affects children and adults; a lung focus is often not active at diagnosis.

Causes

Mycobacterium tuberculosis spread through the blood (often via the paravertebral venous plexus) from a lung or other focus
Reactivation of a dormant focus years later

Risk factors

Living in or coming from an area where tuberculosis is common
HIV infection and other immunosuppression, including biologic therapy
Malnutrition, diabetes and alcohol use
Contact with a person with active tuberculosis; prison or crowded housing

Pathophysiology

Infection usually starts in the front of the vertebral body next to the endplate and spreads under the anterior longitudinal ligament to nearby vertebrae; the disc is affected later than in pyogenic infection. Collapse of the front of the bodies produces angular kyphosis (gibbus). Caseous pus forms cold abscesses that may track along the psoas; pus, debris or deformity can compress the cord.

Classification

Paradiscal (most common), central, anterior or posterior element involvement
Without or with neurological deficit (Pott paraplegia, early from active disease or late from deformity)

Symptoms and signs

Chronic, slowly worsening back pain, most often at the lower thoracic and upper lumbar spine
Local tenderness, muscle spasm and stiffness
Fever, night sweats, weight loss and malaise (may be mild or absent)
Gibbus: a sharp, angular hump of the spine
Cold abscess: a swelling without heat or redness in the flank, groin or thigh (psoas abscess)
Leg weakness, numbness or sphincter changes when the cord is compressed

Diagnosis

Clinical: Long history of back pain with constitutional symptoms in a person at risk; exam for gibbus, abscesses and neurology. Look for tuberculosis elsewhere, especially the lungs.
Tests: CT- or ultrasound-guided biopsy of bone or abscess for acid-fast stain, mycobacterial culture with drug susceptibility, rapid molecular tests and histology (caseating granulomas). ESR and CRP are usually raised. HIV testing is offered to everyone.
Imaging: MRI is the study of choice: vertebral body destruction with relative disc sparing, subligamentous spread over several levels and paraspinal abscesses with thin walls. X-rays show late collapse and kyphosis; chest X-ray looks for lung disease.

Differential diagnosis

Pyogenic vertebral osteomyelitis
Brucellar spondylitis
Spinal metastases or myeloma
Fungal spinal infection
Osteoporotic vertebral fracture

Goal of treatment

Cure the infection, prevent or reverse neurological deficit, and prevent progressive deformity and instability.

Treatment

Medical: Standard multidrug anti-tuberculosis therapy, given for longer than for lung tuberculosis (durations vary between guidelines), with adherence support and susceptibility-guided changes. Most patients are cured with drugs alone.
Conservative: Bracing and protected activity in selected patients while the bone heals.
Procedure: Image-guided drainage of large paraspinal or psoas abscesses.
Surgical: Surgery for neurological deficit, instability, severe or progressive kyphosis, failure of drug treatment, or when a diagnosis is needed: debridement, decompression and stabilisation.
Rehabilitation: Rehabilitation and nutritional support during recovery.

Drugs for this condition

Complications

Paraplegia (Pott paraplegia)
Severe kyphotic deformity
Spinal instability
Drug-resistant tuberculosis
Drug side effects such as hepatotoxicity

Prognosis

Usually good with early diagnosis and complete treatment; many patients with neurological deficit recover with treatment. Late diagnosis, severe deformity and drug resistance worsen the outcome.

Prevention

Early detection and complete treatment of lung tuberculosis
BCG vaccination at birth, which protects children against severe forms
HIV testing and treatment; tuberculosis screening before immunosuppressive therapy

Test yourself

Think of the answer, then tap the question to see it.

Which spinal region is most commonly affected by Pott disease?

The lower thoracic and upper lumbar spine (thoracolumbar junction).

What is a gibbus?

A sharp, angular kyphosis caused by collapse of the front of one or more vertebral bodies.

What is a cold abscess in spinal tuberculosis?

A collection of caseous pus without the heat and redness of a pyogenic abscess, often tracking along the psoas to the groin or thigh.

On MRI, how does Pott disease usually differ from pyogenic spondylodiscitis?

Tuberculosis tends to spare the disc relatively, spreads under the anterior longitudinal ligament over several levels and forms large, thin-walled paraspinal abscesses.

What is the mainstay of treatment for spinal tuberculosis?

Prolonged multidrug anti-tuberculosis therapy; surgery is reserved for deficit, instability, deformity or failure of drugs.

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Educational information, not medical advice. For any symptom, see a health professional.

Sources: Tuberculous Spondylitis (Pott Disease) (StatPearls (NCBI Bookshelf), 2026).

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Representative model, for educational purposes only.

T11 vertebra highlighted on the Durgical 3D model