A 28-year-old presents with progressive lower back pain, constitutional symptoms and a gibbus deformity at the thoracolumbar junction. MRI reveals a paradiscal lesion with end-plate erosion at T12–L1, paravertebral cold abscess, and mild cord compression. The most feared complication that mandates surgical intervention in spinal tuberculosis is:
- A Persistent pain unresponsive to anti-tuberculosis therapy
- B Paraplegia — specifically Pott's paraplegia (paraplegia in Pott's disease) ✓
- C Psoas abscess extension to the inguinal region
- D Gibbus deformity progressing beyond 30°
Explanation
Pott's paraplegia is the most feared complication of spinal tuberculosis, resulting from cord compression by either: (a) 'paraplegia of active disease' — extradural granulation tissue, pus or abscess compressing the cord (early onset, good prognosis with surgery), or (b) 'paraplegia of healed disease' — fibrotic stenosis, kyphotic deformity compressing the cord (late onset, worse prognosis). Paraplegia mandates urgent surgical decompression (anterior/radical surgery) alongside ATT, as untreated cord compression leads to permanent deficit. Psoas abscess (C) and gibbus (D) are managed initially with ATT and surgical correction if deformity is severe (>60°).
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.