A 35-year-old man with spinal tuberculosis at T8–T9 has developed progressive paraplegia over 3 weeks. MRI shows an anterior epidural granuloma compressing the cord. He is unable to walk. He has been on anti-TB chemotherapy for 2 weeks. The most appropriate treatment is:

• A Continue anti-TB drugs only and observe for 6 weeks before surgical decision
• B Add steroids (dexamethasone) to the anti-TB regimen and observe
• C Anterior decompression (debridement) and spinal stabilization combined with anti-TB chemotherapy ✓
• D Posterior laminectomy decompression as urgent surgery

Explanation

Progressive paraplegia due to TB spinal cord compression (Pott's paraplegia) despite 2 weeks of anti-TB chemotherapy is an indication for surgical decompression. Since TB spondylitis predominantly destroys the anterior column, anterior debridement (removal of caseous granuloma, sequestrated disc, cold abscess) with anterior column reconstruction and posterior fixation is the gold standard (Hong Kong procedure). Posterior laminectomy alone is inadequate and potentially destabilizing for anteriorly based compression in a kyphotic spine. Anti-TB chemotherapy alone is appropriate only for early/resolving paraplegia or early disease without cord compromise; new or progressive paraplegia requires urgent surgery.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.