A woman in her 20s presented with low back pain and lower extremity weakness.

Pott’s disease, or tuberculous spondylitis (Pott’s disease), most commonly affects the lumbar region.  Infection spreads slowly from the anterior aspect of the intervertebral joint behind the anterior ligament to the vertebral body, and into the intervertebral disc space.   If not treated the disc will eventually die, causing vertebral narrowing and collapse, distorting the canal anatomy and placing the patient at risk for paraplegia.  This is typically a late finding in Pott’s disease, and a patient with early Pott’s can still have a normal radiographic appearance of the disc spaces.  Therefore, consider referral for a PPD in any patient who presents with chronic, worsening midline lumbar pain, even with a normal lumbar x-ray.