Pott’s Paraplegia

Abstract

Spinal tuberculosis (TB) is a worldwide public health issue which is one of the main causes of disability. In regions with high TB incidence, Pott’s disease, also known as spinal tuberculosis, is also highly prevalent. Osteoarticular tuberculosis, which affects 1–2% of people with tuberculosis, is always a secondary infection that individuals with primary TB elsewhere in the body have. The most serious kind of bone TB is Pott’s paraplegia. The spinal cord is compressed, there is a gradual neurologic loss, and there may be deformity as the infection often starts from the vertebral body with noticeable damage and creation of a cold abscess. The management and treatment of spinal TB is challenging and intricate. Despite the availability of cutting-edge surgical techniques, imaging modalities, and anti-tubercular chemotherapy, managing Pott’s paraplegia can be challenging, particularly for those strains having multidrug resistant capacity. In order to achieve the desired neurological outcome, therapy should be tailored to each patient’s unique needs. Early diagnosis and prompt therapy are the main initial challenges in the management. The pathophysiology, imaging differential diagnosis, neuroimaging characteristics, surgical choice, and neurological prognosis of Pott’s paraplegia patients from previous literatures have been highlighted in this chapter.

1. Introduction

A typical manifestation of extrapulmonary tuberculosis or osteoarticular tuberculosis is Pott disease, commonly referred to as tuberculous spondylitis. It can cause substantial functional impairment and is associated with a significant morbidity. Since ancient times, TB has been recognized and Indian medical writings from about 1000 and 600 BCE have descriptions of it. Sir Percival Pott first identified the clinical symptoms of tuberculosis of the spinal column in 1779, including kyphotic deformity and neurological deficiency in patients from Europe [1, 2, 3, 4].

During the nineteenth and twentieth centuries, the identification of the causative pathogenic microorganism (Mycobacterium tuberculosis), improvements in diagnostic techniques, the development of the Bacillus Calmette-Guerin (BCG) vaccine, chemotherapeutic drugs, and surgical techniques had given humanity significantly better defense against the condition. Since the beginning of time, M. tuberculosis has shared the planet with birds, fish, animals, and people [1, 5].

Through the hematogenous pathway and spine, M. tuberculosis enters the bone, joints and for 50% of cases, spinal involvement is found. Around 90–95% of the vertebral body can have M. tuberculosis, and 5–10% of the posterior vertebral arch’s numerous components. The radiological manifestations of anterior spinal TB are so well-known that plane radiographs are the primary tool used to diagnose the majority of cases. Additional helpful tools include imaging techniques like computed tomography (CT scan) and magnetic resonance imaging (MRI) [6, 7, 8, 9, 10].

Due to international migration, particularly among the immunosuppressed population, the Pott’s illness has lately exhibited a substantial resurgence in industrialized countries. The global community has faced a significant difficulty as a result. Over the past few decades, there has been a concerning rise in the incidence of multidrug-resistant bacterial strains of TB in underdeveloped countries. These factors explain why the illness is still a serious threat to global public health [11, 12, 13, 14].

1.1 Epidemiology

Pott’s illness is particularly prevalent in nations with high rates of TB and HIV/AIDS, but a firm diagnosis is still challenging to make. Osteoarticular tuberculosis, which affects 1–2% of people with the disease, is always a secondary infection that individuals with primary TB elsewhere in the body have. In the vast majority of instances (80%), it may be challenging to identify the illness’s initial location, although the sickness is always present. Osteoarticular tuberculosis is a localized symptom of a disease that affects the entire body [1, 2, 3, 4, 15].

The microorganism M. tuberculosis is mostly found in the lung and causes TB in around one-third of the world’s population. Recently, the World Health Organization’s (WHO) reported the global prevalence and mortality rates of TB based on the data of 200 countries, which indicates a decrease of prevalence since 1990, suggesting significant progress of TB control. According to a previous conducted study of 2013, between 1990 and 2010, TB-related fatalities has been reduced by almost 40% [16, 17, 18]. Despite significant attempts to prevent TB infection, there have been recent increases of TB cases immigration from endemic areas to non-endemic regions of the world. The increase of poverty, unemployment, AIDS infections, and resistance to anti-TB chemotherapeutic medicines also made the TB control measures challenging [16, 17].

1.2 Pathogenesis

The most frequent cause of TB in humans is M. tuberculosis. Mycobacterium microti, Mycobacterium bovis, and Mycobacterium africanum are other mycobacteria that cause human TB. Mycobacterium is a meticulous, aerobic bacteria that grows slowly. Mycobacterium-containing droplets travel through the air and land on the lungs, where alveolar macrophages consume them. Most of these microorganisms are eliminated. Few are capable of surviving and proliferating in macrophages, which causes a type IV inflammatory response that causes granulomas to develop. In this granuloma, bacteria can remain latent and persist for decades [19].

Whether an infection is managed or not depends on how well the host cell-mediated immune response functions. Mycobacterium may escape from granuloma if the immune response against the pathogen is insufficient. A mycobacterium that has escaped can either cause an active lung infection or it can enter other organs through hematogenous and lymphatic routes. With hematogenous spread of infection from a primary location, spinal involvement is typically subsequent. Spinal involvement originates from the lungs or the genitourinary system [20, 21].

Since the intervertebral disc lacks a blood supply of its own, the infection travels there from the vertebra next to it. Mycobacterium enters the highly vascular cancellous bone of the vertebral body through the venous or arterial pathway. Paradisal involvement results from the transmission of infection through the vascular plexus formed by the arterial arcade produced from the posterior and anterior arteries. The valveless Batson’s paravertebral venous plexus system allows for a free flow of blood which is dependent on pressure [22, 23, 24].

1.3 Clinical features

There are several early signs of tuberculosis include night sweats, fever, weight loss etc. whereas, spread to the spine would be determined by a severe back pain, this Patients may face difficulty in standing and walk. Severe back pain is the most frequent symptom of Pott’s disease, however, systematic symptoms such as anorexia, fever, fatigue, night sweats, weight loss etc. are also common. The swelling of infection site might cause weakness or numbness in legs. In complicated tubercular spine disease patient may present with rest pain, deformity, bone destruction, instability and sometimes radicular pain would be main symptom. In Pott’s paraplegia, presence of neurologic deficit is not quite common and percentage of incidence greatly varies (5–100%) due to stages of disease. Pott’s illness can therefore result in a significant curvature of the spine and limb paralysis. Spinal cord involvement in Pott’s illness can be caused by direct pressure from abscess development and/or bone sequestrum [25, 26, 27].

1.4 Neuroimaging features

The majority of tuberculomas were numerous and dispersed across the cerebral hemispheres. Additional spinal cord imaging may be helpful in determining the entire degree of the illness in patients with quadriparesis or paraparesis. Worse prognosis is linked to spinal cord involvement and it is clear that CNS TB is complex. Studies has identified some difference between baseline scans and follow-up scans for majority of cases though only for less than 5% of patients second follow-up scan performed. These follow-up scans usually performed within 3 months of primary scans. After 3 months, we could presume the stabilization of disease process, which is why patients did not get follow-up scans later period such as after 6 month or annually. On subsequent scans, the size and number of tuberculomas either stayed the same, changed, or rose or decreased [28, 29, 30, 31].

According to previous studies, cerebral infarction is an independent predictor of poor prognosis of CNS TB those are mostly acute in nature. On subsequent imaging, several patients had additional infarcts form. There are also some contradictions regarding the infarction’s location. Therefore, in the future, it’s important to strive for a varied and extensive TB distribution in research and intervention studies. In order to connect the site of the infarction with a worse outcome, some studies suggested CT scans in a pediatric population [32, 33].

1.5 Progressive neurological deficit in Pott’s paraplegia

During the active Pott’s paraplegia stage of or after recovery there might be some neurological deficit. The vertebral collapse due to TB would result in the involvement of anterior spinal tract. Later, the posterior column deficiency is followed by a gradual involvement of the lateral spinal pathways. Scores such as Frankel and ASIA ratings would also be used to categorize the neurological deficit in spinal tuberculosis. The most helpful classification for Pott paraplegia with spinal cord involvement is the modified version of Tuli classification [34, 35, 36, 37, 38]. Motor fibers are crushed initially because they are not located similarly, as seen in the typical Pott’s paraplegia or anterior spinal TB. As a result, the sensory fibers are only implicated later [39, 40, 41, 42].

When compression occurs due to anterior or posterior spinal tuberculosis, pressure is initially applied to the column of cerebrospinal fluid around the cord before being conveyed to the ligamentum denticulatum. The claims made by Bosworth et al. that the tubercular pus contains a chemical that prevents the spinal cord from conducting properly appear speculative. The classification of Pott’s disease, whether brought on by anterior or posterior spinal TB, should primarily be based on the level of motor involvement to represent the severity of cord compression. As the degree of compression rises, sensory and autonomic functional loss is increased. Sensory recovery comes before the motor recovery (Figure 1) [34, 43].

Figure 1.

Schematic picture demonstrates the pattern of involvement of musculoskeletal and soft tissue structures in Pott’s disease leads to progressive paraplegia; (A) showing only paradiscal VB involvement with preservation of the disc, vertebral arch and no compression on spinal cord; (B) showing paradiscal VB involvement as well as intervertebral disc with formation of abscess by stripping the ALL and (C) demonstrates huge epidural abscess which is responsible for significant compression on spinal cord with local kyphotic deformity. At this stage, patient develops paraparesis followed by paraplegia.

A previous study has documented 100 instances of TB spine with neurological consequences and among them 33% were reported before 4 weeks, majority (40%) were after 4 weeks and within 3 months, and remaining 27% after 3 months of the neurological deficit first appeared. When an intraspinal tuberculous granuloma is initially observed, it frequently exhibits compressive myelopathy or a cauda equina lesion with sphincter involvement. They are diagnosed with “spinal tumor syndrome,” which covers both tumorous and non-tumorous disorders of the spinal cord and meninges, because they exhibit no clinical spinal deformity upon inspection [44, 45, 46].

1.6 Diagnostic studies

Mycobacterium culture is the gold standard for diagnosing tuberculosis, however as it’s a fastidious microorganism relying solely on positive cultures for diagnosis might have low sensitivity. To confirm the diagnosis, further laboratory reference standards such as microbiological, immunological, hematological, serological, and other diagnostic resources should be employed. MRI is most frequently used for the diagnosis and cold abscess by using ultrasound. Myelography’s has important role diagnosis of patients who do not recover neurologically and in situations where there are multiple skipped multifocal spinal lesions to identify which lesion is causing compression [47, 48, 49].

2. Imaging modalities

2.1 Radiography

With a 15% sensitivity, plain radiographs were proposed previously as an imaging modality for Pott’s disease. As a first stage diagnosis process, conventional lateral radiographs are used to look for TB infection. These radiographs typically show osteolysis affecting the entire vertebral body with diffuse osteopenia [7, 50, 51, 52].

2.2 Computed tomography (CT) scan

With great sensitivity, computed tomography (CT) can assist in the diagnosis at a far earlier stage than ordinary x-rays (100%). CT is a valuable and common diagnostic tool, in cases with Pott’s disease which would able to demonstrates the extension of soft tissue involvement clearly. For the purpose of making a diagnosis, CT scans can also help in image-guided biopsy [7, 50, 51, 52, 53].

2.3 Magnetic resonance imaging (MRI)

With a 100% sensitivity and an 80% specificity, magnetic resonance imaging (MRI) is the most helpful modality in the diagnosis of spinal TB. The location of the abscess, the degree of soft tissue enhancement, and spinal canal impairment are all best detected with MRI. MRI with gadolinium enhancement might offer more details on the diagnosis. We can also identify non-contiguous vertebral involvement by doing screening sequences that include the whole spine. MRI can be used to evaluate therapy response [54, 55, 56]. MRI can also demonstrate the number of lesion and their locations in cold abscesses. Recently published report demonstrates that the early detection of inflammatory oedema could be ensured by T2 STIR images [16].

2.4 Nuclear imaging

Nuclear imaging can provide descriptive evidences of the activities in the affected tissues. These techniques are unable to assist distinguish between cancer or other pyogenic diseases and tubercular infections [57].

2.5 Laboratory tests

Laboratory test such as Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are less common test. ESR has a sensitivity of 90% and CRP a sensitivity of 71%, however has more specificity than ESR [58]. The serological tests have a round of limitations. IgG and IgM (antibody test) levels is not effective to determine the difference of natural TB infection, vaccinated person, active disease, or healed person [59, 60]. Traditional TB culture, Acid-fast bacilli staining, BACTEC assay are some common laboratory techniques [61]. Isolation of Mycobacterium tuberculosis with a computed tomography (CT)-guided needle biopsy or open surgical intervention can yield an accurate diagnosis. In cases receiving anti-TB chemotherapy in the lead up to surgery, it is difficult to show typical acid-fast bacilli on staining with hematoxylin-eosin, and results of TB cultures are typically negative in such cases. Histological examination of formalin-fixed and paraffin-embedded tissue specimen blocks typically provides granulomatous pattern with caseating necrosis and giant-cell granuloma [25, 26, 62].

2.6 Molecular diagnosis

Various types of molecular techniques are useful for the diagnosis with high sensitivity and specificity. Polymerase chain reaction (PCR) with a sensitivity of 75% and specificity of 97%) is used in paucibacillary, extrapulmonary TB infections. Fully automated Gene Xpert MTB/RIF help in the diagnosis of resistance towards antibiotics with high sensitivity and specificity [12, 63]. In between 72% and 97% of patients, specific features such Langhans large cells, epithelioid cell granuloma, and caseating necrosis can be detected through histopathological examinations [64, 65].

2.7 Tests to detect latent tuberculosis

The skin hypersensitivity test has been advocated as a low-cost test; however, it is not a reliable test in areas where patients are immunocompromised. Some studies also suggest the use of the enzyme-linked immunosorbent test (ELISA) and the interferon-gamma release assay [66, 67].

3. Treatment of Pott’s paraplegia

Before treatment of Pott’s paraplegia, it is important determine the severity of the spinal TB disease, based on presentation and symptoms. Uncomplicated disease is treated with antitubercular treatment (chemotherapy) and complicated cases usually need surgical intervention with chemotherapy [68].

The most helpful classification for Pott paraplegia with spinal cord involvement is the modified version of Tuli’s classification which consist of five stages. The First stage includes intense tendon reflexes, ankle clonus, plantar or Babinski extensor. During the second stage patient face a motor deficit (UMN-type) with spasticity. In the stage three patient become spastic and bedridden (motor crore: around 0–30). Patient become bedridden including a severe sensory deficit/pressure sores in the 4th stage. The final or 5th stage is similar to 4th stage bladder or bowel involvement [34, 35].

Oguz et al. proposed a new classification system for Pott’s disease named Gulhane Askeri Tıp Akademisi widely known as GATA. Where they divided Pott’s Paraplegia based on clinical and radiological status into three categories (IA/B, II, and III). GATA suggested surgical treatment for patients with Type IB (no neurological deficit), Type II and Type III (with or without neurological deficit). M. Turgut et al. (2017) presented we a new simple modified classification system from GATA system. The modified system is a simple guide for treatment planning in patients with Pott’s disease for young spinal surgeons [69, 70].

3.1 Conservative treatment and chemotherapy

The cornerstones in the treatment of spinal TB are antitubercular medications (Isoniazid, Rifampicin, Ethambutol, and Pyrazinamide). It addresses both the main tubercular foci present elsewhere in the body as well as the spinal TB. Also recommended is higher-dose, shorter-course intermittent chemotherapy that is administered three times each week [71].

Recently established protocols recommends anti-TB chemotherapy with 2 months of isoniazid (INH) (5–15 mg/kg), pyrazinamide (PZA) (30–40 mg/kg), rifampicin (RIF) (10–20 mg/kg), and ethambutol (EMB) (15–25 mg/kg), followed by INH and RIF (next 4 months) [16]. According to the British Medical Research Council, combined chemotherapy should be used to treat tuberculous spondylitis of the thoracolumbar spine for 6–9 months. A 4.5-month ultra-short course of chemotherapy has been suggested, although bigger trials and longer follow-up studies are still needed [71].

In addition to latent and quickly growing forms, tubercle bacilli can also exist in intracellular and extracellular forms. In order to combat the bacilli in their many phases or forms and decrease the occurrence of medication resistance, a multi-drug therapy is required. The WHO advises a six-month course of multidrug anti-tubercular therapy, which includes 2 months of “initiation” phase therapy with a four/five-drug regimen and 4 months of “continuation” phase therapy with a two-drug regimen containing isoniazid and rifampicin. The American thoracic spine society (ATSS) advises a 9-month therapy plan using the same medications. When there is resistance to or poor tolerance to first-line treatments, additional second-line anti-tubercular therapies, such as kanamycin, capreomycin, pyrazinamide, and amikacin, among others, are often recommended. Beside some contradiction, the WHO has continued to recommend DOTS therapy for optimum results [72, 73, 74, 75].

Research conducted in in the pre-chemotherapeutic period observed that, up to 66% of patients with Pott’s paraplegia demonstrated neurological improvement by strictly conservative therapy. The idea was bolstered in the post-chemotherapeutic period by the observation that pure conservative treatment with chemotherapy resulted in neurological improvement in 60–80%of patients [47, 76, 77, 78, 79].

4. Surgical management

4.1 Principles

The phrase “middle route regimen” was first used in the context of treating TB by Tuli et al. This protocol suggested medical management for all patients together with surgical management when it was necessary, such as in cases of chemotherapy failure, neurological weakness, recurrent illness, instability, neuro deficiency, incapacitating pain, or deformity. Because tubercle bacilli do not create a biofilm, implants can be used to stabilize tubercular infections [12, 80, 81, 82].

Neurosurgeons and orthopedic surgeons that specialize in spine surgery usually treat Pott’s paraplegia. In individuals with Pott’s illness who have signs of spinal cord or nerve root compression, researchers advise surgical decompression in addition to medicinal care. In order to achieve decompression in individuals with spinal instability, percutaneous needle aspiration of the caseous necrosis has been recommended. Due to the severe state of the disease in the majority of patients, a meta-analysis recommended treating the condition with anti-TB chemotherapy and surgery. For high-risk Pott’s disease patients, minimally invasive interventional radiology procedures, open or percutaneous internal fixation techniques, and anti-TB chemotherapy have recently been introduced [16, 25, 26, 83, 84].

4.2 Anterior approach, posterior approach and combined approach

Debridement using an anterior approach have historically been employed to treat the diseased tissues directly since TB spine mostly affects the anterior spinal components. However, the anterior approach has reportedly been linked to significant side effects, including death, graft-related problems, and method-related issues. Patients without any involvement of the posterior spinal structures, without panvertebral illness, are the best candidates for anterior surgery [85, 86, 87].

For a variety of reasons, including ease of use and familiarity, posterior techniques are more frequently used in contemporary spine surgery for TB spondylitis. The advantage include, less morbidity, strong pedicle screw system, and the capacity for circumferential decompression [88, 89, 90, 91, 92].

As the combination method is usually linked with major morbidities and problems, it should only be used for severe destructive lesions with severe deformities or fundamentally unstable spines. The methods might be applied in a single stage or many stages [93, 94]. Based on the aforementioned reasons, majority of surgeons propose combined anterior and posterior operation which enables sufficient focus debridement and stabilization after kyphosis correction (Figure 2) [95, 96, 97].

Figure 2.

A 23-year-old male presented with progressive spastic paraparesis for 2 months with intact autonomic function. MRI, midsagittal T2WI-whole spine screening film demonstrated hyperintense signal change sporadically involved the spinal column. Variable stages of VB and disc involvement, prevertebral and epidural abscess formation, kyphotic deformity, significant spinal cord compression and proximal syrinx formation present (A). After administration of gadolinium, there is heterogenous contrast enhancement (B). Patient underwent percuatenous drainage of the presacral abscess and received antitubercular chemotherapy, follow up MRI after 1 month demonstrated resolution of the syrinx, improvement of abnormal signal changes, as well as extent of spinal cord compression and (C). Later on, decompression and fixation done on D3,4,6,7 in second sitting to decompress the spinal cord and to correct the deformity.

4.3 Surgery in healed tuberculosis

Age, the degree of the deformity, concomitant conditions, the region of the spine involved, the number of levels involved, and the surgeon’s choice should all be taken into account before deciding whether to operate on a patient with an unstable illness. In the thoracic and thoracolumbar levels at the peak of kyphosis, anterior approach might be particularly challenging. The most common posterior techniques are closing opening wedge osteotomy, pedicle subtraction osteotomy/closing wedge osteotomy, posterior vertebral column resection, transpedicular decancellation, and Ponte’s osteotomy. In more severe abnormalities, diseases affecting two or three vertebrae, or complicated revision procedures, both anterior and posterior techniques may be necessary [98, 99, 100, 101, 102].

4.4 Management during pregnancy

Pott’s disease during pregnancy reported to be rare & can be associated with destruction of the intervertebral disc & adjacent vertebrae that can lead to cord compression. The effects of extrapulmonary tuberculosis infection during pregnancy depend on the site of involvement, the severity and duration of disease, and the occurrence of pregnancy-related complications. The safety of the first-line drugs for the management of active tuberculosis in pregnancy has been established, and therapy improves both maternal and neonatal outcomes. There is no malformation or teratogenicity identified in pregnant patients taking these drugs. Streptomycin should be avoided in pregnancy as it is ototoxic to the fetus. The WHO recommends ATT for 9 months but most experts prefer to continue ATT for one to 2 years. Some experts advocate early surgical decompression in all while others prefer to operate after delivery [103, 104, 105].

As per general guidelines for spinal surgery in pregnant women with progressive neurological deficit, delivery should be induced or cesarean section is performed before spinal surgery at 34–36 weeks of gestation or later. In cases earlier than 34–36 weeks of gestation, prepartum spinal surgery should be performed. Surgery and anesthesia during advanced pregnancy are associated with increased risk of spontaneous abortion, preterm labor, prematurity and low birth weight. Pregnant women with paraplegia have increased incidence of urinary tract infection, decubitus ulcer, preterm labour & autonomic hyperflexia [104, 105, 106].

4.5 Management of children

Children are one of the most vulnerable group for being affected by the Pott’s paraplegia. Hematogenous spread from the original site of infection is the major method of infection in children. Children with spinal TB frequently experience symptoms in the dorsal spine; only around 5% of kids experience symptoms in the cervical spine [107, 108, 109, 110].

The mainstay of the care of pediatric spinal TB continues to be conservative therapy, which includes chemotherapy and orthopedic immobilization. The American Thoracic Society and the Centers for Disease Control and Prevention made it obvious that a minimum of 12 months of treatment is necessary for bone and joint TB. However, some recent findings claimed that a shorter duration would be suitable for those with spinal TB [111, 112, 113].

Large abscesses, especially those in the psoas muscle, should be treated surgically. In addition, children who exhibit or acquire neurological deficiency during follow-up must have surgery to stop permanent paralysis or deteriorating deformities. In children with spinal TB, a severe kyphosis of more than 60° occurs in around 3 percent of cases. Children under the age of 10, the involvement of three or more vertebral bodies, and the location of the lesion in the thoracic spine are risk factors for severe kyphotic deformity. A severe kyphosis compromises one’s appearance and causes cardiac malfunction and compression of the spinal cord. The surgical method is also not uniform globally. To describe the surgical method, processes, surgical stages, challenges, and difficulties for correcting the kyphosis of 60° or more, prospective studies are required [111, 114, 115]. One-stage posterior instrumentation combined anterior debridement and fusion were demonstrated to be a safe and effective method to achieve spinal decompression and kyphosis correction in children with thoracic and lumbar spinal TB.

In treatment of children with multiple-level tuberculosis causing evident kyphosis and with extensive abscesses, posterior screw instrumentation prior to anterior approach usually applied. Posterior instrumentation enabled best correction of the sagittal profile, restoration of vertebral height and reconstruction of segmental stability by appropriate distraction in active stages of spinal TB. Ponte osteotomies usually performed to increase flexibility and facilitate correction. For patients with seriously compressed spinal cord, laminectomy is performed before deformity correction. Furthermore, combined anterior and posterior fusions can prevent the imbalanced spinal growth of children, and maintain long-term correction [116, 117].

4.6 Rest, braces and traction

Braces have importance and are still frequently required. Forcing people to slumber for more than 6–9 months on a hard bed or a plaster-of-Paris bed may even be detrimental, leading to skin, lung, gastrointestinal, and metabolic issues. Braces are frequently more torment and pseudo-satisfaction tools than actual tools. Due to the significant deforming pressures, braces cannot stop the progression of kyphotic deformity. Therefore, braces are typically not very helpful. Any brace that a patient often removes for personal care, a bath, or pain loses its intended function. The only brace which may be useful is trauma cervical brace for cranio-occipital and few cases of cervical spine tuberculosis. Halo frames are used for stabilization, not for traction or distraction [71, 118].

4.7 Future research on Pott’s Paraplegia

During the last two decade a significant improvement has been made in terms of diagnosis and treatment of Pott’s Paraplegia. However, more research is required regarding the improvement management and treatment especially surgical procedure in various conditions. Research is required for development of more prompt diagnosis, management and treatment to reduce severe consequences and complications. Extensive study is required on the preventive treatment and quick screening of Pott’s disease among children. Now a days, MDR is bothering all countries as it requires more investigations for proper treatments. Early identification of drug resistance and prescription of suitable drugs for appropriate duration is the key to manage Pott’s spine. We also recommend more research in the area rehabilitation as it is a crucial component to improve the quality of life of patients. There is also a lack of research in the area of kyphosis correction.

5. Conclusion

The treatment of spinal TB illness is difficult and intricate. Spinal tuberculosis can be treated by anybody who can cure TB. The contributions of all levels of health service provider are highly important for the management of Pott’s paraplegia, even though the treating surgeon plays the majority of the patient management role. When there is a neurological deficiency or deformity, orthopedic surgeons are typically needed. With very few exceptions, managing Pott’s spine and paraplegia based on paraplegia grading is straightforward, rational, effective, and simple to remember. Early diagnosis and prompt therapy are the main initial challenges in the management of the condition. The next significant step is determining the disease-related consequences and making the right choice regarding whether long-term treatment is necessary in addition to surgical procedures. The difficulties in administering long-term chemotherapy, such as side effects and complications from the medication, problems with compliance, socioeconomic variables, and others, are also very important.