A 30-year-old man with spinal tuberculosis at T8-T9 develops acute paraplegia. MRI shows cord compression from a paravertebral abscess with early kyphotic deformity. He has been on ATT for 6 weeks. The pott's paraplegia in this case is MOST LIKELY 'paraplegia of onset' or 'early paraplegia.' What is the primary indication for surgical decompression in this scenario?

• A Paraplegia is an absolute contraindication to surgery in spinal TB
• B Any degree of neurological compromise at any stage requires immediate surgery before starting ATT
• C The duration of ATT is irrelevant; surgery depends only on the degree of kyphosis
• D Failure to improve or worsening neurological status after 4 weeks of adequate ATT ✓

Explanation

Pott's paraplegia of onset (early-onset, occurring within 2 years of disease) is most often caused by mechanical compression (abscess, sequestrum, caseous tissue) and is potentially reversible. Management algorithm: all patients with early Pott's paraplegia begin ATT + supportive care; surgical decompression is indicated if neurological deficit fails to improve or worsens after 4 weeks of adequate ATT, if the diagnosis is uncertain, or if there is complete paraplegia at presentation or rapid deterioration. Surgery (anterior decompression — transpedicular or costotransversectomy/anterolateral decompression) removes the compressive pathology and corrects kyphosis. Late paraplegia (>2 years) from fibrous tissue requires operative decompression more promptly as it does not respond to ATT.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.