A 30-year-old presents with Pott's disease at T8-T9 with a gibbus deformity and MRC Grade 3 weakness of both lower limbs. MRI shows extensive bone destruction with a large paravertebral abscess compressing the cord anteriorly. The most appropriate surgical approach is:

• A Posterior decompressive laminectomy alone
• B CT-guided abscess drainage alone followed by anti-TB therapy
• C Conservative anti-TB therapy with external bracing without surgery
• D Anterior debridement and fusion via transthoracic approach with posterior instrumentation ✓

Explanation

Pott's disease with neurological deficit (MRC Grade 3 — active movement against gravity but not resistance) and anterior cord compression from bone destruction and abscess requires anterior decompression and reconstruction. The pathology is anterior (vertebral body destruction and anterior abscess), so posterior laminectomy alone removes the posterior stabilisers without addressing the anterior compressive pathology and may worsen instability. Combined anterior debridement, strut grafting/cage placement, and posterior pedicle screw fixation (360° stabilisation) provides decompression, structural support, and fusion — the current gold standard for Pott's with significant neurological deficit and spinal instability.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.