Pott's Paraplegia
Paraplegia is the most dreaded complication of Spinal TB. It occurs when the spinal cord is compressed by the products of infection (pus, debris) or bony deformity.
1. Classification (Onset)
- Early Onset (Active Disease): Occurs within 2 years. Prognosis is Good because compression is usually fluid/soft tissue (Abscess, Granulation tissue, Sequestrum, Disc).
- Late Onset (Healed Disease): Occurs after many years. Prognosis is Poor. Causes:
- Internal Gibbus: Bony ridge compressing cord.
- Recrudescence: Reactivation of infection.
2. Grading (Griffith)
- Stage 1: Negligible weakness, patient unaware. Extensor Plantar.
- Stage 2: Mild weakness but patient can walk.
- Stage 3: Severe weakness (Non-ambulatory) + Sensory loss.
- Stage 4: Complete paralysis + Sphincter loss.
3. Management
- Early Onset: Often resolves with ATT + Rest. Surgery if no improvement in 3-4 weeks.
- Surgery: Anterolateral Decompression (ALD) or Costotransversectomy to remove anterior compression.
25 Practice MCQs
Q1. Early onset Pott's paraplegia usually has a:
Answer: A). Fluid/granulation tissue resolves with drugs/drainage.
Q2. Late onset paraplegia is often due to:
Answer: B). Stretching of the cord over the deformity.
Q3. Which factor is an absolute indication for surgery?
Answer: A). Or onset of paraplegia during treatment.
Q4. The "Internal Gibbus" refers to:
Answer: A). It impinges the cord anteriorly.
Q5. "Spinal Tumor Syndrome" in TB refers to:
Answer: A). MRI is diagnostic here.
Q6. Clonus (repetitive rhythmic contractions) indicates:
Answer: A). Typical in Pott's Paraplegia.
Q7. Anterolateral Decompression (ALD) accesses the spine via:
Answer: A). Standard for thoracic TB.
Q8. Conservative trial for paraplegia typically lasts:
Answer: A). If no recovery, surgery is indicated.
Q9. Which spinal level has the worst prognosis for recovery?
Answer: A). Vascular supply is also precarious (Watershed).
Q10. "Healing with defects" causes:
Answer: A). 10-30 degree increase in kyphosis is common during healing.
Q11. Sequestrum in TB refers to:
Answer: A). Can compress the cord.
Q12. If patient has Grade 4 paraplegia (0/5 power) for > 6 months, prognosis is:
Answer: A). Cord atrophy likely.
Q13. Laminectomy is contraindicated in Pott's Paraplegia because:
Answer: A). "Disaster surgery" for TB.
Q14. "Concertina Collapse" is more typical of:
Answer: B). Vertebra plana. TB causes wedging.
Q15. Does paralysis in TB involve the bladder/bowel early?
Answer: B). Unlike traumatic injury.
Q16. Caseous necrosis looks like:
Answer: A). Hallmark of TB.
Q17. Which drug is NOT first line ATT?
Answer: C). HRZE regimen is standard.
Q18. Shingling is:
Answer: A). Associated with costotransversectomy.
Q19. What is "Recrudescence"?
Answer: A). Cause of late paraplegia.
Q20. Hartshill Rectangle is an implant used for:
Answer: A). Older sublaminar wiring technique.
Q21. Main cause of Post-Tubercular Kyphosis is:
Answer: A). Wedge collapse.
Q22. Spasticity suggests lesion:
Answer: A). UMN signs.
Q23. Extensor Plantar Response (Babinski) is a sign of:
Answer: A). Often first sign of Pott's paraplegia.
Q24. Bed rest duration in conservative management depends on:
Answer: A). Then mobilize with brace.
Q25. Can TB affect the posterior elements (lamina/pedicle) primarily?
Answer: A). Called Posterior Spinal TB.
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