Management in a rehabilitation department in Pott's disease

Abstract

Tuberculous spondylitis, or Pott's disease, is a public health problem in Tunisia, where it occurs as an endemic disease. It is the most common and most severe articular bone tuberculosis. It is responsible for a major handicap because of its location and its destructive nature. This work aims to assess the contribution of rehabilitation for patients with Pott's disease. A retrospective study that included 29 patients with Pott's disease and hospitalized in PMR Service. An assessment before and after rehabilitation was made to assess the recovery of muscle strength, of the bladder and sphincter disorders (BUD) and functional independence measurement (FIM score). The average age of patients was 46.7 years, the sex ratio of 1.1. The location was cervical in 5 cases, dorsal in 16 cases, lumbar in 7 cases and a patient had cervical, dorsal and lumbar locations. All patients were put under quadruple tuberculosis and underwent surgery decompression and then sent to a rehabilitation care. Two patients were quadriplegia, 3 patients quadriparesis, 14 patients were in complete paraplegia and other incomplete paraplegia. All patients had an array of central neurogenic bladder, and the average MIF score was 62.3. After a mean hospital stay of 32 days with twice-daily sessions of appropriate rehabilitation, 8 patients were still incontinent paraplegics and the bladder sphincter plane but autonomous wheelchair. After a mean of 2 years, the average MIF score was 112. Five patients had disorders of the spinal posture during the treatment requiring revision surgery with osteosynthesis. Pott's disease diagnosis may be delayed in absence of neurological signs. MRI allows early diagnosis. Treatment is medical and surgical. Rehabilitation is a crucial component to improve the quality of life of these patients.