A 40-year-old woman with thoracic Pott's disease and paraplegia of 3 weeks duration (ASIA B) undergoes anterior decompression, bone grafting, and posterior instrumented fusion. What is the earliest reliable clinical indicator of neurological recovery post-surgery?

• A Return of bladder control
• B Presence of movement in the hip flexors and knee extensors
• C Voluntary anal sphincter contraction returning
• D Recovery of deep tendon reflexes below the lesion ✓

Explanation

After surgical decompression for Pott's paraplegia, recovery of spinal cord function follows a predictable sequence: deep tendon reflexes (DTR) return first (within hours to days), as they are the most elemental spinal reflex arcs. This is followed by return of voluntary motor control (weeks to months), and ultimately bladder function and sensation. Returning DTRs (initially absent or diminished in spinal shock) are the earliest reliable clinical indicator of recovering cord function after decompression. ASIA B indicates preserved sacral sensory function with no motor function — conversion to ASIA C/D (motor recovery) is the treatment goal.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.