MEDICAL-SURGICAL TREATMENT OF PROGRESSIVE TUBERCULOUS (POTTS) PARAPLEGIA IN GABON

The present study deals with the results of the medical-surgical treat ment of 22 patients with Pott's tetraplegia or paraplegia. Seventeen h ad progressive tetraplegia-paraplegia which failed to respond solely t o medical treatment. On admission, four patients exhibited an acute on set tetraplegia-paraplegia, and one had a 'spinal tumour syndrome'. In addition to antituberculous therapy, seven patients had anterior spin al surgery, consisting of four corporectomies, two anterior debridment s and grafting, and one debridment alone. Moreover, one patient had a posterior interbody fusion, four had laminotomies, and 10 had laminect omies. The causes of the spinal cord or cauda equina compression, as w as determined at operation, were extradural abscess in eight patients, bony compressions in 11, arachnoiditis in two, and posterior neural a rch tuberculosis in one patient. Neurological recovery began between 1 0 and 21 days postoperatively. The mean length of follow-up was 42.36 months (range 8-144 months). Fourteen patients were found to be functi onally and neurologically normal at follow-up examinations (63%). Eigh ty-two per cent recovered sufficiently to walk unaided. Two patients w ere left paralysed and unable to walk. Two patients were able to get a bout on crutches. The onset of objective improvement soon after surgic al decompression suggests a causal effect. It was concluded that early neural decompression and spinal stabilisation provided the maximum po tential for neurological recovery.