A patient with Pott's spine at T8-T9 level presents with lower limb spastic paraplegia. The appropriate surgical treatment for this neurological deficit when there is active disease with cord compression from anterior granulation/abscess is:

• A Posterior laminectomy and decompression alone
• B Anterior debridement (radical surgery — Hong Kong procedure), decompression, bone grafting and instrumented fusion ✓
• C Posterior long-segment instrumentation without anterior debridement
• D Conservative management with ATT alone; surgery contraindicated in active TB

Explanation

Neurological deficit from Pott's spine (spastic paraplegia) with anterior cord compression (granulation, caseous material, or epidural abscess) requires anterior surgical decompression (radical debridement — Hong Kong procedure) combined with anterior bone grafting and supplementary posterior instrumentation. Posterior laminectomy alone is contraindicated because the compression is anterior, and removing posterior elements further destabilizes the spine. ATT alone is reserved for neurological deficit due to spinal instability without cord compression, or in early disease with minor deficits. Radical surgery provides better neurological recovery (MRC ≥2 grade) and spinal reconstruction.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.