A patient with Pott's disease at L1–L2 presents with severe kyphosis and bilateral lower limb weakness (Frankel Grade C). MRI shows cord compression from posterior kyphosis with a gibbus. The most appropriate surgical approach for decompression and deformity correction is:

• A Anterior radical debridement, decompression, bone grafting with posterior instrumentation ✓
• B Posterior laminectomy alone
• C Conservative ATT alone for 18 months
• D Posterior pedicle subtraction osteotomy alone

Explanation

In Pott's disease with neurological deficit (Frankel C), the compression is anterior (vertebral body collapse, gibbus, caseous material) — laminectomy alone worsens kyphosis and provides inadequate decompression. The gold standard is combined anterior approach: radical debridement of diseased bone and pus, anterior cord decompression, structural bone grafting (strut graft) for reconstruction, combined with posterior pedicle screw instrumentation for deformity correction and stabilization (anterior-only with cage is also used). ATT alone is inadequate in Frankel C with structural instability.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.