It’s Never Too Late: Neurological Outcome of Delayed Decompression in Tuberculosis of Spine

Abstract

Study Design: Retrospective observational study. Objective: To study the neurological recovery in patients with progressive neurological deficit undergoing delayed decompression and fixation in tuberculosis of spine. Methods: Retrospective analysis of 50 cases with thoracolumbar tuberculosis of spine, undergoing posterior decompression and instrumentation was done. Parameters like time interval between appearance of neurological deficit to decompression surgery, maximal spinal cord compression, neurology on admission, presence of drug resistance, and number of vertebrae involved were evaluated. The subjects were divided into 2 groups depending on neurological improvement measured with LEMS (Lower Extremity Motor Score) at the end of 1-year follow-up. Results: The mean LEMS score on admission was 27.72 (SD 12.88), which improved to 40.80 (SD 10.46) at the end of 1 year ( P < .001). A total of 26 (52%) subjects were categorized into “Satisfactory” outcome (LEMS >10) group and remaining 24 subjects formed the “nonsatisfactory” outcome group. The median time interval between the appearance of neurological deficit and decompression surgery was 23.50 days in the satisfactory group and 29.50 days ( P = .110) in the nonsatisfactory group. Maximal spinal cord compression was 0.370 in satisfactory group and 0.357 in nonsatisfactory group ( P = .754). The mean preoperative LEMS score was 34.62 in the satisfactory outcome group while that in the nonsatisfactory outcome group was 20.25 ( P < .001). Conclusion: There is significant scope for neurological improvement even after delayed decompression and fixation in cases of tuberculosis of spine with progressive neurological deficits. Preoperative neurological status was found to be the most significant determinant of postoperative neurological outcome.

Efficacy and Sagittal Parameters of Debridement and Bone Grafting using Internal Fixation in the Treatment of Kyphotic Cervical Tuberculosis: A Case Series

“…In the treatment of patients with severe vertebral destruction, collapse, or vertebral dislocation, combined anterior and posterior approach surgery should be considered to reconstruct vertebral body stability when the anterior approach surgery alone cannot achieve stability reconstruction [5,12,26,27]. Combined anterior and posterior approach surgery (anterior approach of debridement or decompression combined with the posterior approach of pedicle screw xation) is superior to only anterior approach surgery in biomechanical stability [28].…”

“…Anti-TB chemotherapy is effective and practical in the early stage of TB. However, the early symptoms of TB disease are too insidious to notice and are diagnosed until the middle or advanced stage [11,12, 16]. Hence, surgical intervention is required by patients with cervical deformity, neurological compression symptoms, and necrotic tissue, which is caused by an abscess or drug resistance of anti-TB [17].…”

“…The abscess may spread to the surrounding tissues and compresses the trachea, esophagus, and neck vessels, which caused neurological symptoms due to posterior compression of the spinal cord by a cold abscess in some patients [6][7][8][9][10]. Mostly, the intervertebral disc is involved, then resulting in cervical instability and spinal cord neurological dysfunction.At present, comprehensive treatment, based on anti-TB (TB) chemotherapy, surgery, and nutritional support therapy, is usually used for cervical spine TB [11][12][13][14][15][16]. Anti-TB chemotherapy is effective and practical in the early stage of TB.…”

Response to Letter to the Editor on “It’s Never Too Late: Neurological Outcome of Delayed Decompression in Tuberculosis of Spine”

“…As mentioned in our article, the indications for surgery were taken as progressive neurological deterioration, failure to respond to chemotherapy, bowel/bladder involvement, spinal deformity, and instability. 1 Kindly note that those patients who were improving on the antituberculous therapy (ATT) were neither operated upon nor were they part of this study.…”

Letter to the Editor on “It’s Never Too Late: Neurological Outcome of Delayed Decompression in Tuberculosis of Spine” by Rathod et al

“…We read with great interest the recent article by Rathod et al highlighting the scope of neurological improvement in spinal tuberculosis even with delayed surgery. 1 We appreciate the efforts of the authors to stimulate discussion on an important aspect of management in patients with spinal tuberculosis. However, we wish to register some of our observations in the belief that it will send out the message expounded in this study with greater clarity.…”