Exploring Thoracolumbar Pott's Disease in the Immunocompetent; Institutional Experience Over a Decade and Comprehensive Literature Review.

Background: The presentation of Pott's has a wide variation and an insidious onset, which makes timely accurate diagnosis quite challenging.

Objective: To review Pott's cases to enhance the disease management and fill the literature gap regarding the approach to Pott's disease.

Methods: A descriptive observational retrospective hospital-based study conducted from 2007 to 2022 at KFHU. 346 patients who were diagnosed with TB were reviewed thoroughly. Only 13 cases were labeled as Pott's disease based on imaging or microbiology testing and hence were included in this study, and other TB pulmonary and extrapulmonary cases were excluded.

Results: In our analysis of 13 cases of Pott's disease, we observed a significant male predominance (69.23%) and diverse symptoms, with back pain (69.2%) being most prevalent among our patients. Lumbar involvement was the most frequently observed site (38.4%), and diagnoses were made through microbiology (69.2%) or clinical/radiological means (30.8%). Acid-fast bacilli (AFB) culture testing exhibited a positivity rate of 61.5%, while TB-PCR showed positive results in 57.1%. Imaging studies revealed vertebral lesions (90.9% CT, 81.8% MRI), abscesses (54.5% CT, 81.8% MRI), and spondylodiscitis (18.2% CT, 54.5% MRI). Treatment, administered in 92.3% of cases, involved the use of Isoniazid, Rifampicin, and Ethambutol. Surgical interventions, though less frequent, encompassed various procedures. Outcomes demonstrated a notable high cure rate of 84.9%, with a 15.4% incidence of cases experiencing loss of follow-up.

Conclusion: The high cure rate of 84.9% accentuates the effectiveness of early diagnosis and comprehensive treatment strategies that combine medical and surgical interventions when necessary.