Bone and joint infections: late-onset paraplegia of healed spinal tuberculosis: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Bone and joint infections: late-onset paraplegia of healed spinal tuberculosis

Sample item

A 45-year-old man was treated for dorsal spine tuberculosis 20 years ago and healed with a severe kyphosis. He now has slowly progressive spastic paraparesis, and the ESR is normal. What is the most likely cause of the cord compression?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Cord stretched over an internal bony gibbus at the apex of the kyphosis

Late-onset paraplegia of healed disease occurs years after the infection has healed. The cord is tethered and compressed over the internal bony ridge at the apex of a severe kyphosis, aggravated by fibrosis and canal narrowing. Treatment is anterior decompression and stabilisation, as antitubercular drugs alone will not relieve a mechanical block.

Option by option

  • A. Tuberculous meningitis with arachnoiditis

    Meningitis does not cause a slowly progressive, level-related spastic paraparesis at the site of a healed kyphosis.

  • B. Reactivation with a large epidural abscess

    An epidural abscess is a cause of early-onset paraplegia during active disease and would be accompanied by a raised ESR.

  • C. Cord stretched over an internal bony gibbus at the apex of the kyphosis (correct)

    Correct. Years after healing, mechanical compression over the internal gibbus causes slowly progressive paraplegia.

  • D. Sequestrated disc fragment from the acute stage

    Disc and bone sequestra cause compression in the active phase of infection, not two decades afterwards.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is C, Cord stretched over an internal bony gibbus at the apex of the kyphosis. Late-onset paraplegia of healed disease occurs years after the infection has healed.

Why is "Tuberculous meningitis with arachnoiditis" not the answer?

Meningitis does not cause a slowly progressive, level-related spastic paraparesis at the site of a healed kyphosis.

Why is "Reactivation with a large epidural abscess" not the answer?

An epidural abscess is a cause of early-onset paraplegia during active disease and would be accompanied by a raised ESR.

Why is "Sequestrated disc fragment from the acute stage" not the answer?

Disc and bone sequestra cause compression in the active phase of infection, not two decades afterwards.

What concept does this question test?

It tests Bone and joint infections: late-onset paraplegia of healed spinal tuberculosis in Orthopaedics. The cord is tethered and compressed over the internal bony ridge at the apex of a severe kyphosis, aggravated by fibrosis and canal narrowing. Treatment is anterior decompression and stabilisation, as antitubercular drugs alone will not relieve a mechanical block.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Bone and joint infections: late-onset paraplegia of healed spinal tuberculosis?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.