Paraplegia of late onset in adolescents with healed childhood caries of dorsal spine: A cause of pressure on the cord and treatment

BACKGROUND: Paraplegia of late onset in adolescents with caries of dorsal spine is considered to be due to the reactivation of infection. Internal salient at the level of acute kyphotic deformity of the dorsal spine is formed by posterior cartilaginous remains of grossly destroyed vertebral bodies. The author presents a study of eight adolescent patients with paraplegia of late onset associated with severe kyphotic deformity of dorsal spine with observations on the cause of paraplegia, the final neurological outcome following anterior decompression and its prevention. MATERIALS AND METHODS: Eight adolescent patients mean age 14.4 yrs 6 males and 2 females with healed childhood caries of dorsal spine, having a mean kyphotic angle of 80° (range 60°–140°) presented with paraplegia of late onset. Of these patients, two had medical research council grade 0 muscle power; four had grade 2 muscle power, and two others had grade 3 muscle power in the lower limbs and were unable to walk unaided. One patient with 140° kyphoscoliotic deformity with grade 3 muscle power had post-polio residual paralysis (PPRP) in addition. All patients were subjected to thorough anterior spinal decompression through transthoracic, transpleural thoracotomy from the left side. RESULTS: In six of the eight patients, the spine at the site of deformity being very rigid, the deformity could not be corrected and the intervertebral gap was bridged with appropriate autogenous tricortical cortico cancelluous bone graft. In one patient (case 4), the kyphotic deformity could be corrected by 50%. In one patient with 140° kyphosis and PPRP, the gap after the decompression of cord, could not be bridged with bone graft and was given a custom made, well molded plastic black shell to wear while walking and, in particular, while traveling in a vehicle. In all seven patients, bone grafts took six months for bridging the intervertebral gaps. All patients recovered to grade 4 muscle power 6–12 months after surgery. CONCLUSION: In adolescents with healed caries of dorsal spine with acute kyphosis and paraplegia, the treatment of choice is anterior surgical decompression of the cord and bridging the gap thus created with bone graft.