A 28-year-old with Pott's spine at T8-T9 develops sudden onset paraplegia with preserved bladder sensation. MRI shows a large anterior epidural granuloma compressing the cord without bony collapse. What is the most appropriate initial intervention?
- A Initiate standard 4-drug ATT and observe for neurological recovery
- B Emergency anterior corpectomy and fusion with strut graft ✓
- C Emergency decompressive laminectomy
- D Start high-dose corticosteroids as sole treatment
Explanation
When Pott's spine causes paraplegia due to anterior epidural granulation tissue or caseous material, the compression is anterior; decompressive laminectomy (posterior approach) does not address the anterior pathology and can cause iatrogenic instability. The surgical approach of choice is anterior (transthoracic or retroperitoneal) corpectomy, debridement of granuloma, and stabilisation with strut graft ± instrumentation. ATT is essential but alone will not rapidly decompress an established mechanical compressive paraplegia. High-dose steroids are an adjunct in spinal cord injury, not a primary treatment for tuberculoma.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.