Potts Paraplegia * It is a most serious complication of spinal TB,incidence is appr 20%. * MC in dorsal spine because it is the narrowest region,abcess remains confined under tension and even a small compromise can lead to neurological deficit,infection is common in this area and spinal cord terminates below L1 * Early onset paraplegia- occurs during active phase of disease,usually within 2 yrs-ourable prognosis * Late onset- After many yrs,poor prognosis Causes of Paraplegia * Early onset :-Inflammatory causes- Abcess(MC) Granulation tissue Circumscribed TB focus Post spinal disease Infective thrombosis Mechanical causes- Seuestrum in canal,infected degenerated disc in canal,pathological dislocation * Late Onset:- Reccurance Internal gibbus fibrous septa following healing Grades of Paraplegia I. Negligible - Patient unaware of Neuro-deficit, physician detects extensor planter and ankle or patella clonus II. Mild - Patient aware of deficit but manages to walk with/without suppo+signs of spasticity. Ill. Moderate - Non ambulatory because of severe weakness,paraplegia in extension on examination. IV. Severe - Pt unable to walk,Paraplegia in flexion with severe muscle spasm,near complete loss of sensation with sphincter disturbance. Management * Usually possible to diagnose clinically and by typical radiological signs.CT scan may be done to see type of veebral destruction,cause of paraplegia i.e.pus,sequestra etc * Treatment of Paraplegia: Three schools of thought:- 1.Innmediate operative decompression, of cord by ant debridement-* improvement occurs in sho time.Otherwise TB penetrates the duramaterrecovery impossible. 2.Initially immobilisation or complete bed rest,if no improvement in specified time than surgery. 3.Middle path regimen-wait for 4 weeks to recover with rest and ATT,if no improvement than surgical decompression. REF : MAHESWARI 9TH ED