Diagnosis of Pott’s Paraplegia
Pott’s paraplegia is neurological dysfunction caused by tuberculous infection of the vertebral column, usually with spinal cord or cauda equina compression. It most often affects the thoracic or thoracolumbar spine, where the spinal canal is relatively narrow and the cord has limited tolerance to deformity. The neurological deficit may occur during active infection or after the disease has apparently healed. Diagnosis requires correlation of the clinical syndrome with evidence of spinal tuberculosis and demonstration of neural compression or cord injury.
Pathological basis
Spinal tuberculosis usually begins in the anterior part of the vertebral body adjacent to the end plate. Infection spreads beneath the anterior and posterior longitudinal ligaments, producing destruction of two adjoining vertebral bodies and the intervening disc. Caseation may form a paravertebral, epidural or subligamentous abscess. Progressive vertebral collapse causes kyphosis and may produce anterior cord kinking. Neurological impairment can result from epidural granulation tissue, abscess, sequestrated bone, diseased disc, pathological displacement, instability, or vascular compromise of the cord.
In late disease, paraplegia may develop despite healed infection because of a rigid angular kyphosis, internal gibbus, post-tuberculous stenosis, recurrent mechanical compression or delayed cord traction. Therefore, absence of fever or constitutional symptoms does not…