Pott’s Disease during Pregnancy – A Physical Medicine and Rehabilitation Approach to Improve Function: A Case Report

Abstract

Objective: To assess the role of physical medicine and rehabilitation (PM&R) in an interdisciplinary
team approach in managing a pregnant woman with Pott’s disease.
Methods: A 24 year-old female in her 31st week of pregnancy (G2P0A1) with a diagnosis of
C4 tetraplegia AIS C and accompanying problems such as, premature ruptured of membrane,
spondylitis tuberculous, cardiovascular compliance changes, weakness of all limbs, sensory deficit,
severely dependent ADL (Barthel Index 60), and moderate depression. She was managed by an
inter-disciplinary team. The short-term goals were saving the infant, protecting the spinal cord
and its function and improving the psychological condition. The ultimate rehabilitation goals were
independent ambulation, independent ADL, which increases the quality of life and helping her get
back to work. Rehabilitation management included cervico-thoracal orthoses with FELR control for
vertebral immobilization, mobilization exercises, active breathing exercises, ROM exercises of all
of her limbs, improving cardiovascular endurance and sensory re-education.
Results: During conservative therapy, the patient used a cervical collar brace and tuberculous drugs
category 1 except streptomycin. A caesarean section was performed on May 24th, 2013, followed
by operative decompression and vertebral stabilization procedure with a pedicle and screw 1 week
after (May 31st, 2013). Afterwards, the patient used cervico-thoracal orthoses with FELR control for
vertebral immobilization. The histologic examination showed granulomatous inflamation supported
Spondylitis tuberculous. Within 3 months of physical medicine and rehabilitation management,
the Barthel Index, which was initially 60 (Severe dependent Activity Daily Living/ ADL), became
100 (independent ADL). Physical Medicine and Rehabilitation management included mobilization
exercises, active breathing exercises, ROM exercises of all of her limbs, improving cardiovascular
endurance and sensory re-education. Overall, the increased quality of life of this patient reflected the
successful inter-disciplinary team management.
Conclusion: The PM&R approach in the interdisciplinary team resulted in an optimal functional
recovery of the patient with Pott’s disease during pregnancy.
Keywords: Pott’s disease, pregnancy, physical medicine and rehabilitation, function