Volume 17 | Issue 3 | July – September 2022 | Page 5-11 | Shailesh Hadgaonkar, Divakar Modipalli, Siddarth Aiyer, Pramod Bhilare, Ajay kothari, Parag Sancheti
Authors: Shailesh Hadgaonkar , Divakar Modipalli , Siddarth Aiyer , Pramod Bhilare , Ajay kothari , Parag Sancheti 
 Sancheti Institute for Orthopaedics and Rehabilitation Shivajinagar, Pune, Maharashtra, India 41103
Address of Correspondence
Dr. Divakar Modipalli,
Sancheti Institute for Orthopaedics and Rehabilitation Shivajinagar, Pune, Maharashtra, India 41103
Study Design: Review article
Objective: To present a review of literature on the epidemiology, pathophysiology, diagnosis and outline evidence-based management strategy for paraplegia in Pott’s spine
Methods: A systematic literature search was performed using PubMed systematic Reviews. Studies published over the last 20 years were analysed and conclusions were drawn. The search was conducted using key words “Tuberculosis of Spine”, “Paraplegia” and “Management”.
Results: Early diagnosis and timely initiation of treatment is the key to successful treatment of Spinal Tuberculosis (STB) with neurological deficit. Surgery along with appropriate chemotherapy is the mainstay of treatment when STB is complicated by neurological deficits. In cases of late onset neurological deficit, the decision regarding the surgical approach is based on the severity and location of the deformity, and the nature of pathology causing the neurological deficits. Surgery is warranted in case of the early-onset spinal TB complicated by neurological deficits, disease compromising the spinal stability, spinal deformity and in patients presenting with progressive neurological deficits. Surgery for late onset neurological deficits and deformity are associated with complications like worsening of the neurological deficits, persistence of the deformity and suboptimal outcome.
Conclusions: Tuberculosis is a medical disease and chemotherapy is the cornerstone of treatment. Surgery in early disease for neurological deficits/spine instability is associated with good neurological recovery. Surgery in late onset disease is necessary to correct
deformity and arrest progression of neurological deficits, However is associated with inferior outcomes
Keywords: Spinal tuberculosis, Pott’s paraplegia, Neurological deficits, chemotherapy, Late onset paraplegia, kyphosis, Surgical approach
1. S. M. Tuli, “Historical aspects of Pott’s disease (spinal tuberculosis) management,” Eur. Spine J., vol. 22, no. S4, pp. 529–538, Jun. 2013, doi: 10.1007/s00586-012-2388-7.
2. T. Apostolou, P. Givissis, I. Chatziprodromidou, I. Pinto, L. Tagalidis, and P. Savvidis, “Spinal Tuberculosis,” Int. J. Orthop., vol. 2, no. 2, Art. no. 2, Apr. 2015, doi: 10.6051/ijo.v2i2.971.
3. A. K. Jain, “Treatment of Tuberculosis of the Spine With Neurologic Complications:” Clin. Orthop., vol. 398, pp. 75–84, May 2002, doi: 10.1097/00003086-200205000-00011.
4. H. J. Seddon, “Pott’s paraplegia: Prognosis and treatment,” Br. J. Surg., vol. 22, no. 88, pp. 769–799, Apr. 1935, doi: 10.1002/bjs.1800228813.
5. A. R. Hodgson and A. Yau, “Pott’s paraplegia: A classification based upon the living pathology,” Spinal Cord, vol. 5, no. 1, pp. 1–16, May 1967, doi: 10.1038/sc.1967.2.
6. A. K. Jain and J. Kumar, “Tuberculosis of spine: neurological deficit,” Eur. Spine J., vol. 22, no. S4, pp. 624–633, Jun. 2013, doi: 10.1007/s00586-012-2335-7.
7. S. Rajasekaran, “The Problem of Deformity in Spinal Tuberculosis,” Clin. Orthop. Relat. Res., vol. 398, pp. 85–92, May 2002.
8. L. C. Hsu, C. L. Cheng, and J. C. Leong, “Pott’s paraplegia of late onset. The cause of compression and results after anterior decompression,” J. Bone Joint Surg. Br., vol. 70, no. 4, pp. 534–538, Aug. 1988.
9. A. K. Jain and I. K. Dhammi, “Tuberculosis of the Spine: A Review,” Clin. Orthop., vol. PAP, Apr. 2007, doi: 10.1097/BLO.0b013e318065b7c3.
10. A. K. Jain, A. Aggarwal, and G. Mehrotra, “Correlation of canal encroachment with neurological deficit in tuberculosis of the spine,” Int. Orthop., vol. 23, no. 2, pp. 85–86, Jun. 1999, doi: 10.1007/s002640050313.
11. A. K. Jain, “Tuberculosis of the spine: A FRESH LOOK AT AN OLD DISEASE,” J. Bone Joint Surg. Br., vol. 92-B, no. 7, pp. 905–913, Jul. 2010, doi: 10.1302/0301-620X.92B7.24668.
12. E. Pertuiset et al., “Spinal Tuberculosis in Adults: A Study of 103 Cases in a Developed Country, 1980-1994:,” Medicine (Baltimore), vol. 78, no. 5, pp. 309–320, Sep. 1999, doi: 10.1097/00005792-199909000-00003.
13. R. Jain, S. Sawhney, and M. Berry, “Computer tomography of vertebral tuberculosis: Patterns of bone destruction,” Clin. Radiol., vol. 47, no. 3, pp. 196–199, Mar. 1993, doi: 10.1016/S0009-9260(05)81162-6.
14. S. M. Tuli, “Treatment of Neurological Complications in Tuberculosis of the Spine,” JBJS, vol. 51, no. 4, pp. 680–692, Jun. 1969.
15. A. K. Jain and S. Sinha, “Evaluation of systems of grading of neurological deficit in tuberculosis of spine,” Spinal Cord, vol. 43, no. 6, pp. 375–380, Jun. 2005, doi: 10.1038/sj.sc.3101718.
16. P. C. Jutte and J. H. van Loenhout-Rooyackers, “Routine surgery in addition to chemotherapy for treating spinal tuberculosis,” Cochrane Database Syst. Rev., no. 1, 2006, doi: 10.1002/14651858.CD004532.pub2.
17. “5585665076Index-TB Guidelines.pdf.” Accessed: Jul. 16, 2020. [Online]. Available: https://tbcindia.gov.in/WriteReadData/l892s/5585665076Index-TB%20Guidelines.pdf.
18. S. B. Kohli, “RADICAL SURGICAL APPROACH TO SPINAL TUBERCULOSIS,” J. Bone Joint Surg. Br., vol. 49-B, no. 4, pp. 668–673, Nov. 1967, doi: 10.1302/0301-620X.49B4.668.
19. M. K. Goel, “TREATMENT OF POTT’S PARAPLEGIA BY OPERATION,” J. Bone Joint Surg. Br., vol. 49-B, no. 4, pp. 674–681, Nov. 1967, doi: 10.1302/0301-620X.49B4.674.
20. A. R. Hodgson, F. E. Stock, H. S. Y. Fang, and G. B. Ong, “Anterior spinal fusion the operative approach and pathological findings in 412 patients with pott’s disease of the spine,” Br. J. Surg., vol. 48, no. 208, pp. 172–178, Sep. 1960, doi: 10.1002/bjs.18004820819.
21. A. Shetty, R. M. Kanna, and S. Rajasekaran, “TB spine—Current aspects on clinical presentation, diagnosis, and management options,” Semin. Spine Surg., vol. 28, no. 3, pp. 150–162, Sep. 2016, doi: 10.1053/j.semss.2015.07.006.
22. I. T. Benli, A. Kaya, and E. Acaroglu, “Anterior Instrumentation in Tuberculous Spondylitis: Is it Effective and Safe?,” Clin. Orthop. Relat. Res., vol. 460, pp. 108–116, Jul. 2007, doi: 10.1097/BLO.0b013e318065b70d.
23. G. Zaveri, “The role of posterior surgery in spinal tuberculosis,” ArgoSpine News J., vol. 23, no. 3, pp. 112–119, Sep. 2011, doi: 10.1007/s12240-011-0022-x.
24. M. M. Sahoo, S. K. Mahapatra, G. C. Sethi, and S. K. Dash, “Posterior-only Approach Surgery for Fixation and Decompression of Thoracolumbar Spinal Tuberculosis: A Retrospective Study,” J. Spinal Disord. Tech., vol. 25, no. 7, pp. E217–E223, Oct. 2012, doi: 10.1097/BSD.0b013e31826a088e.
25. S.-H. Lee, J.-K. Sung, and Y.-M. Park, “Single-stage Transpedicular Decompression and Posterior Instrumentation in Treatment of Thoracic and Thoracolumbar Spinal Tuberculosis: A Retrospective Case Series,” J. Spinal Disord. Tech., vol. 19, no. 8, pp. 595–602, Dec. 2006, doi: 10.1097/01.bsd.0000211241.06588.7b.
26. S. Rajasekaran and S. Soundarapandian, “Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis,” J. Bone Joint Surg. Am., vol. 71, no. 9, pp. 1314–1323, Oct. 1989.
27. S. Rajasekaran, D. C. R. Soundararajan, A. P. Shetty, and R. M. Kanna, “Spinal Tuberculosis: Current Concepts,” Glob. Spine J., vol. 8, no. 4_suppl, pp. 96S-108S, Dec. 2018, doi: 10.1177/2192568218769053.
28. S. M. Tuli, “Severe kyphotic deformity in tuberculosis of the spine,” Int. Orthop., vol. 19, no. 5, Oct. 1995, doi: 10.1007/BF00181121.
29. S. Rajasekaran, “Buckling Collapse of the Spine in Childhood Spinal Tuberculosis:,” Clin. Orthop., vol. PAP, Apr. 2007, doi: 10.1097/BLO.0b013e31806a9172.
30. K. H. Bridwell, “Decision Making Regarding Smith-Petersen vs. Pedicle Subtraction Osteotomy vs. Vertebral Column Resection for Spinal Deformity:,” Spine, vol. 31, no. Suppl, pp. S171–S178, Sep. 2006, doi: 10.1097/01.brs.0000231963.72810.38.
31. S. Rajasekaran, S. R. Rajoli, S. N. Aiyer, R. Kanna, and A. P. Shetty, “A Classification for Kyphosis Based on Column Deficiency, Curve Magnitude, and Osteotomy Requirement:,” J. Bone Jt. Surg., vol. 100, no. 13, pp. 1147–1156, Jul. 2018, doi: 10.2106/JBJS.17.01127.
32. K.-Y. Ha and Y.-H. Kim, “Late onset of progressive neurological deficits in severe angular kyphosis related to tuberculosis spondylitis,” Eur. Spine J., vol. 25, no. 4, pp. 1039–1046, Apr. 2016, doi: 10.1007/s00586-015-3997-8.
33. Y. W. Wong, D. Samartzis, K. M. C. Cheung, and K. Luk, “Tuberculosis of the spine with severe angular kyphosis: mean 34-year post-operative follow-up shows that prevention is better than salvage,” Bone Jt. J., vol. 99-B, no. 10, pp. 1381–1388, Oct. 2017, doi: 10.1302/0301-620X.99B10.BJJ-2017-0148.R1.
34. W. Hua et al., “Incidence and risk factors of neurological complications during posterior vertebral column resection to correct severe post-tubercular kyphosis with late-onset neurological deficits: case series and review of the literature,” J. Orthop. Surg., vol. 13, no. 1, p. 269, Dec. 2018, doi: 10.1186/s13018-018-0979-7.
|How to Cite this article: Hadgaonkar S, Modipalli D, Aiyer S, Bhilare P, kothari A, Sancheti P. Paraplegia in pott’s spine: evidence-based management strategy a review article. Journal of Trauma and Orthopaedic Surgery July-Sep 2022;17(3) : 5-11.|