Bone and joint infections: surgery for tuberculous paraparesis: 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: surgery for tuberculous paraparesis

Sample item

A 30-year-old with dorsal spine tuberculosis has had four weeks of antituberculous drugs, but his paraparesis is worsening. MRI shows an anterior abscess and caseous debris compressing the cord. Which approach is preferred?

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

The answer and the reasoning

A. Anterior decompression with debridement and stabilisation

Neurological deterioration despite chemotherapy is an indication for surgery. Because the disease and compression are anterior, the abscess is evacuated by an anterior or anterolateral approach with grafting and stabilisation. Laminectomy does not reach the anterior pathology and removes posterior stabilisers, worsening kyphosis and deficit.

Option by option

  • A. Anterior decompression with debridement and stabilisation (correct)

    Correct. The anterior pathology is removed directly and the column is stabilised.

  • B. Posterior laminectomy alone

    Laminectomy cannot reach the anterior disease and destabilises an already unstable spine.

  • C. Systemic corticosteroids alone

    Steroids alone do not remove abscess or bone compressing the cord.

  • D. Continued drugs with bed rest in a plaster jacket

    Waiting leaves a progressive deficit untreated when drugs have already failed to help.

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 A, Anterior decompression with debridement and stabilisation. Neurological deterioration despite chemotherapy is an indication for surgery.

Why is "Posterior laminectomy alone" not the answer?

Laminectomy cannot reach the anterior disease and destabilises an already unstable spine.

Why is "Systemic corticosteroids alone" not the answer?

Steroids alone do not remove abscess or bone compressing the cord.

Why is "Continued drugs with bed rest in a plaster jacket" not the answer?

Waiting leaves a progressive deficit untreated when drugs have already failed to help.

What concept does this question test?

It tests Bone and joint infections: surgery for tuberculous paraparesis in Orthopaedics. Because the disease and compression are anterior, the abscess is evacuated by an anterior or anterolateral approach with grafting and stabilisation. Laminectomy does not reach the anterior pathology and removes posterior stabilisers, worsening kyphosis and deficit.

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: surgery for tuberculous paraparesis?

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.