A 35-year-old presents with Pott's spine with paraplegia of sudden onset after years of back pain and a kyphotic deformity. MRI shows vertebral body collapse at T10–T11 with large anterior and posterior epidural abscess. The paraplegia is most likely due to:

• A Intradural tuberculous meningitis directly invading the cord
• B Anterior spinal artery occlusion from vasculitis affecting the radicular vessels
• C Vertebral fracture causing traumatic hemarthrosis in the spinal canal
• D Extradural compression by abscess/granulation tissue or mechanical cord compression from bony deformity ✓

Explanation

Paraplegia in Pott's disease has two main mechanisms: 'active disease' paraplegia, which occurs during active infection and is caused by extradural abscess, granulation tissue, sequestra, or subluxation compressing the cord; and 'healed disease' (late-onset) paraplegia, caused by progressive kyphotic deformity mechanically stretching and angulating the cord over the gibbus. Urgent surgical decompression (anterior debridement with strut grafting ± posterior instrumentation) is required. Intradural invasion and vascular occlusion are rare secondary mechanisms.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.