Paraplegia in Tuberculous Spondylitis

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Paraplegia in Tuberculous Spondylitis

Paraplegia is the most serious complication of tuberculosis of the spine. The incidence is reported at between 10% and
29%.[162,207] The current incidence is much lower, owing to better diagnosis and early treatment. Younger children are
more likely to become paraplegic.
Hodgson and colleagues classified paraplegia into four types. [105] The first is paraplegia of active disease resulting from
external compression of the cord and dura. The compression comes from caseating pus, sequestra of bone and disk,
dislocation of vertebrae, and granulation tissue within the spinal canal. Clinically, these patients have varying degrees of
spasticity of the lower limbs but do not have involuntary muscle spasms and withdrawal reflex. This type of paraplegia
carries a good prognosis for full recovery after decompression and stabilization.
The second type is paraplegia due to direct tuberculous involvement of the spinal cord. In these cases tuberculous
meningitis and myelitis are present. These patients have more severe spasticity with involuntary muscle spasm and
withdrawal reflex. This type of paraplegia is associated with a poor prognosis for recovery.
The third type of paraplegia occurs after healing and is due to fibrosis of the meninges and granulation tissue causing
cord compression.
The fourth type is due to rare causes such as thrombosis of vessels supplying the cord.
When paraplegia occurs, the level and type of lesion are determined by radiography, MRI, and myelography. Spinal fluid
cell count and total protein determination determine the extent of intradural infection. Early anterior decompression is
strongly recommended, followed by spinal stabilization. Delay in treatment may result in permanent paraplegia.[105]

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Pediatric Orthopaedics

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