Neuroplasticity and activity-based rehabilitation of a patient with post-surgical chronic Pott’s spine: a case report (2025)

  • Raveena Kini1,
  • Prachita Walankar1,
  • Aman Minocha1 &
  • Vrushali Panhale1

Bulletin of Faculty of Physical Therapy volume30, Articlenumber:4 (2025) Cite this article

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Abstract

Background

India has a widespread prevalence of Pott’s disease, with an increased affection seen in young males. The common complications associated with it are spinal deformity and sensory-motor deficits in the limbs, which are based on the level of spinal affection.

Case presentation

We present a case of a 17-year-old male, with a history of Pott’s spine for 14years. He has reported with anterior wedge compression and resorption of T7, T8, and T9 vertebral bodies along with Gibbus spine deformity and subsequent spinal cord compression. He underwent posterior decompression and spinal fixation with rods and pedicular screws and was referred to physiotherapy post-operatively. There is limited evidence about the emerging benefits of neuroplasticity in sequentially progressed sensorimotor skill retraining and activity-based learning as a part of rehabilitation. The patient underwent sequentially progressed mobility, balance, strength training, and activity-based relearning, which positively impacted the patient's recovery and improved quality of life.

Conclusion

Neuroplasticity and activity-based learning assisted in improving the functional status and quality of life in a patient surgically managed with decompression and spinal fusion post-Potts spine.

Introduction

Tuberculosis (TB) of the spine, also known as Pott’s disease, is very common in developing nations [1]. One of the complications associated with it is Gibbus spine deformity, wherein one or more vertebral bodies collapse leading to progressive kyphosis and, if left untreated, causing spinal cord compression and paraplegia [2]. When a cord is compressed chronically, as confirmed by radiological evidence, it can undergo plasticity, which involves changes in the activation pattern of the structure or function of the affected neurons [3]. This forms a strong basis for sensory-motor retraining based on the level of cord compression, a subset of motor relearning, in the rehabilitation program [4].

A case report by Mandhane et al. demonstrated that customized physiotherapy program focussed on traditional methods like involving mobility training, progressive muscle strength, and endurance training, aerobic training, and sensory re-education for 6weeks improved patient’s overall functional independence [5]. Likewise, a review by Dhouibi et al. reported that rehabilitation program of a Pott’s spine patient should be focussed on tailored and holistic approach aiming to reduce the level of disability and enhance the quality of life. This review emphasizes the need to develop evidence-based customized programs [6]. Studies highlight that spinal interneurons undergo certain neuroplastic circuit rearrangements in a couple of days post the spinal cord injury, contributing to or hindering functional recovery [7]. This aspect of neuroplasticity can be utilized well to ensure better recovery by aligning the rehabilitation program towards it. A study done by Kathe et al. on incomplete spinal cord injuries mouse model demonstrates that interneuron subtypes mediating locomotor recovery are induced by electrical epidural stimulation with rehabilitation due to spinal circuit rearrangements favoring the recruitment of functionally relevant interneuron subtypes [8]. This indicates that activity-based functional training could help in the formation of such neuronal circuits. To the best of our knowledge, there is limited evidence on emerging benefits of neuroplasticity, in sequentially progressed sensorimotor skill retraining. To further add on to this existing evidence on the traditional methods of rehabilitation of Pott’s spine, this case report talks about the importance of incorporating the activity-based training in supine, sidelying, sitting, and standing that aids in better neuronal rearrangements and ensures positive use of neuroplasticity in faster recovery of the patient post decompression and stabilization of the spine.

We report here a case of a 17-year-old young male, with a history of Pott’s spine and Gibbus spine deformity, managed with posterior decompression and rods and pedicle screws fixation. Apart from the traditional methods, he was rehabilitated with a major focus on sensory-motor skill restoration, based on motor relearning theory.

Case presentation

A 17-year-old male student, with a history of conservatively managed Pott’s spine 14years ago, came to a tertiary care hospital with chief complaints of sharp shooting pain, progressive bilateral lower limb weakness, and difficulty in walking for 3months. A lateral view of the spine revealed exaggerated thoracic kyphosis and anterior wedge compression fracture at T7, T8, and T9 levels (Fig.1). A posterior decompression and spinal fixation with rods and pedicular screws were done from T7 to T10 vertebral segments (Fig.2). After the orthopedic medical management, the patient was referred to physiotherapy.

Lateral radiograph of the thoracolumbar showing exaggerated thoracic kyphosis and anterior wedge compression fracture at T7, T8, and T9 levels

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Lateral radiograph of the thoracolumbar showing spinal fixation with rods and pedicular screws done from T7-T10 vertebral segments

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A thorough evaluation was done from physiotherapy perspective. Increased kyphosis and forward head posture were seen. The patient reported 9/10 pain on the Numerical Rating Scale at the suture site. Range of motion was not initially assessed objectively as the patient had undergone spinal fixation; wherein spinal movements were contraindicated. Motor examination using myotome assessment revealed major deficits in L2 and L3. Hypertonia was seen in hip extensors, knee flexors, and ankle plantar flexors bilaterally. Hyperreflexia was noted with a positive Babinski sign, ankle clonus, and an exaggerated knee reflex. Furthermore, sensory evaluation was carried out using light touch, which was absent in dermatomes L1-S2. The functional assessment revealed moderate difficulty maintaining trunk balance, sit to stand, and walking without support. Respiratory system assessment showed reduced air entry in bilateral middle and lower zones. When objectively measured, chest expansion was decreased at all levels, with 0.5 inches at the apical and mammary levels and 1 inch at the xiphisternum level.

As per the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) scale, sensory level was T12, and myotomes were impaired at L2 level with partial preservation zones at L3, L4, and L5. Likewise, quality of life was assessed using SF-36 scale.

The major focus of rehabilitation program was sensory motor retraining and functional activity-based training. As mentioned previously, activity-based rehabilitation would lead to functionally relevant interneurons with the assistance of neuroplasticity and would positively favor recovery [8]. The surgery done ensured vertebral column stability, deformity correction, and decompression of the cord, while the rehabilitation was planned towards sensory and motor training of the newly formed neural tissue. Postoperatively, short-term goals were patient education, preventing respiratory and secondary complications, reducing pain and edema, improving strength, promoting early mobility, and encouraging independent activities of daily living. Long-term goals focused on improving muscle and cardiorespiratory endurance, balance, and functional independence (Table1). There was an improvement in the motor functions concerning the myotomal assessments and quality of life (Table2).

Full size table

Discussion

This case highlights the enhanced motor recovery, using the principles of neuroplasticity and activity-based rehabilitation, for a patient who underwent spinal decompression after being diagnosed with chronic Pott’s spine with neurodeficits. Neurodeficits are associated with cord compression that may be a byproduct of vertebral deformity, majorly kyphosis, which occurs secondary to the negligence or lack of appropriate medical management leading to chronically present symptoms of Pott’s spine [1, 2]. This kyphosis, if progressed, can lead to a Gibbus deformity [3].

A thorough assessment of the patient revealed there was a considerable sensory-motor deficit due to the chronic cord compression, which had now been decompressed using a surgical approach. Even though the neurological structures are decompressed, the chronically compressed structures undergo recovery by sprouting of neuronal tissues which we ensured by providing the required optimum external stimuli in the rehabilitation process. The physiotherapy rehabilitation focused on sensory-motor retraining, based on principles of motor relearning and neuroplasticity. It included mobility exercises, posture correction, breathing exercises with a focus on improving respiratory muscle endurance, step-by-step functional re-education with progressive complexity, simultaneous core stabilization and strengthening exercises along with balance and proprioception training, and gait training [5].

The rehabilitation proposed in our case was also based on the study done by Hitwar et al., where a target-based therapy program was designed to reduce post-operative pain, and edema, increase range of motion, and enhance patient responsiveness in the rehabilitation of lumbar spine fracture with posterior decompression and fusion with pedicle screws fixation [9]. Moreover, functional activities were added step by step based on motor relearning principles [10]. This breaking down of the functional activities from simple to complex movements, gave similar outcomes to that of a study done by Jones et al., wherein they saw early and improved neurological recovery with enhanced walking ability [11]. The spinal cord is a key site for activity-dependent neuroplasticity of the corticospinal system [12]. Sensorimotor retraining is a form of mechanical neuromodulation which recruits spinal neuroplasticity to improve function after spinal cord injuries by promoting activity-dependent corticospinal axon sprouting and synapse formation [12].

Similarly, an improvement in the quality of life was observed. This agrees with the study done by Anneken et al., which stated that focused physiotherapy program boosted social and psychological well-being by increasing self-confidence, thereby improving the quality of life [13]. Thus, activity-based learning positively impacted the patient’s recovery and quality of life after the surgery. This treatment approach is significant because there is limited evidence regarding the benefits of using neuroplasticity in rehabilitation for patients with such advanced spinal deformities associated with neurological deficits. The right rehabilitation techniques play a significant role to enhance the effects of the surgery positively.

This case report discusses the benefits of neuroplasticity in sequentially progressed sensorimotor skill retraining and activity-based learning as part of rehabilitation for Potts's spine. Future research should focus on implementing holistic training in a larger sample size for the generalizability of results. Also, quality randomized controlled trials utilizing sequentially progressed sensorimotor skill retraining as a part of rehabilitation strategies should be conducted.

Conclusion

Neuroplasticity and activity-based learning assisted in improving the functional status and quality of life in a patient surgically managed with decompression and spinal fusion post-Potts spine. This case report adds an evidence-based approach to apply sequentially progressed sensorimotor skill retraining and activity-based learning in a Pott’s spine patient.

Data availability

The data sets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

TB:

Tuberculosis

ISNCSCI:

International Standards for Neurological Classification of Spinal Cord Injury

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Acknowledgements

The authors acknowledge the patient for his participation in the study.

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Authors and Affiliations

  1. Department of Musculoskeletal Physiotherapy, MGM College of Physiotherapy, Sector 30, Vashi, Maharashtra, Navi Mumbai, 400705, India

    Raveena Kini,Prachita Walankar,Aman Minocha&Vrushali Panhale

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  1. Raveena Kini

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  2. Prachita Walankar

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  3. Aman Minocha

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  4. Vrushali Panhale

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Contributions

RK has contributed to the concept, design, literature search, data collection and analysis, manuscript preparation, editing, and review. PW has contributed to the concept, design, literature search, data collection and analysis, manuscript preparation, editing, and review. AM has contributed to the design, literature search, data collection and analysis, and manuscript preparation. VP has contributed to the concept, design, literature search, manuscript preparation, editing, and review. The authors have read and approved the final manuscript.

Corresponding author

Correspondence to Prachita Walankar.

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Written informed consent was obtained from the patient for publication of this case report and accompanying images.

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The authors declare that they have no competing interests.

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Neuroplasticity and activity-based rehabilitation of a patient with post-surgical chronic Pott’s spine: a case report (3)

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Kini, R., Walankar, P., Minocha, A. et al. Neuroplasticity and activity-based rehabilitation of a patient with post-surgical chronic Pott’s spine: a case report. Bull Fac Phys Ther 30, 4 (2025). https://doi.org/10.1186/s43161-025-00269-z

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Keywords

  • Neuroplasticity
  • Physiotherapy
  • Potts spine
  • Rehabilitation
  • Spine surgery
Neuroplasticity and activity-based rehabilitation of a patient with post-surgical chronic Pott’s spine: a case report (2025)
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