A 35-year-old presents with back pain, fever, and progressive lower limb weakness over 3 months. MRI shows D10–D11 vertebral body destruction with anterior wedging, disc space narrowing, and a large paravertebral abscess tracking to the right psoas. This is Pott's spine. The neurological complication (paraplegia) in early-onset Pott's disease is most commonly due to:

• A Granulation tissue compressing the spinal cord anteriorly
• B Vertebral collapse with mechanical cord compression from gibbus (bone block)
• C Transverse myelitis from TB toxins
• D Caseous abscess compressing the cord ✓

Explanation

In early-onset (active) Pott's paraplegia, the cord compression is primarily from caseous pus, granulation tissue, or caseous material — all soft tissue elements — compressing the cord anteriorly. This is sometimes called 'paraplegia of disease' and responds well to anti-TB chemotherapy with or without surgical decompression. In contrast, late-onset (healed) Pott's paraplegia (paraplegia of healing) is caused by bony compression from the gibbus deformity and requires surgical decompression. Distinguishing these two is critical for management decisions.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.