A patient with thoracic spine tuberculosis develops progressive kyphosis and paraplegia. MRI shows cord compression from an epidural abscess at T7–T8 with vertebral collapse. The Pott's paraplegia in this case is BEST classified as:

• A Paraplegia of early onset — due to mechanical compression by abscess/granulation tissue or caseous material ✓
• B Paraplegia of early onset — due to direct tuberculous myelitis (infection of cord itself)
• C Paraplegia of late onset — due to cord stretching over a healed bony ridge (spine on the taut bow)
• D Paraplegia of late onset — due to vascular insufficiency secondary to aortic compression

Explanation

Pott's paraplegia is classified by timing: Early onset (active disease, within 2 years of onset) — caused by mechanical compression from epidural abscess, caseous material, granulation tissue, or sequestrum; responds well to antituberculous therapy and surgery. Late onset (healed/arrested disease, >2 years) — caused by cord stretching over bony ridge (the 'spine on a taut bow' mechanism), internal gibbus, reactivation, or fibrous band; poor response to ATT alone, requires surgical correction. The present case has active disease with abscess = early onset, Type 1 (compressive). Surgical decompression (anterolateral decompression/costotransversectomy) is indicated when ATT fails or there is rapid neurological deterioration.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.