<prompt> The early feature of Potts paraplegia is -Flexor spasmIncreased tendon jerkAnkle clonusSensory loss  <response>: Potts Paraplegia It is a most serious complication of spinal TB,incidence is appr 20. MC in dorsal spine because it is the narrowest region,abcess remains confined under tension and even a small compromise can lead to neurological deficit,infection is common in this area and spinal cord terminates below L1 Early onset paraplegia- occurs during active phase of disease,usually within 2 yrs-ourable prognosis Late onset- After many yrs,poor prognosis Causes of Paraplegia Early onset :-Inflammatory causes- AbcessMC Granulation tissue Circumscribed TB focus Post spinal disease Infective thrombosis Mechanical causes- Seuestrum in canal,infected degenerated disc in canal,pathological dislocation Late Onset:- Reccurance Internal gibbus fibrous septa following healing Grades of Paraplegia I. Negligible - Patient unaware of Neuro-deficit, physician detects extensor planter and ankle or patella clonus II. Mild - Patient aware of deficit but manages to walk withwithout supposigns of spasticity. Ill. Moderate - Non ambulatory because of severe weakness,paraplegia in extension on examination. IV. Severe - Pt unable to walk,Paraplegia in flexion with severe muscle spasm,near complete loss of sensation with sphincter disturbance. Management Usually possible to diagnose clinically and by typical radiological signs.CT scan may be done to see type of veebral destruction,cause of paraplegia i.e.pus,sequestra etc Treatment of Paraplegia: Three schools of thought:- 1.Innmediate operative decompression, of cord by ant debridement- improvement occurs in sho time.Otherwise TB penetrates the duramaterrecovery impossible. 2.Initially immobilisation or complete bed rest,if no improvement in specified time than surgery. 3.Middle path regimen-wait for 4 weeks to recover with rest and ATT,if no improvement than surgical decompression. REF : MAHESWARI 9TH ED 