A 35-year-old man with spinal TB at T10-T11 develops acute onset paraplegia with spastic lower limbs. MRI shows epidural granulation tissue compressing the cord. The best surgical approach is:

• A Anterior corpectomy with cage reconstruction and anterior plate ✓
• B Posterior laminectomy to decompress the spinal cord
• C Posterolateral (transpedicular or costotransversectomy) approach for anterior decompression
• D CT-guided aspiration of the epidural abscess

Explanation

In thoracic spinal TB, the compression is anterior (from destroyed vertebral body, disc material, and caseous pus). Posterior laminectomy does not address anterior compression and may destabilize the already kyphotic spine, worsening neurological deficit. The standard surgical approach is anterior corpectomy (debridement of the infected anterior column) with structural cage or strut graft reconstruction, supplemented by anterior plate or posterior pedicle screws. Posterolateral approaches allow some anterior debridement when full anterior exposure is not feasible but are less ideal for thoracic TB. Aspiration alone is inadequate for solid granulation tissue compression.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.