Early predictive factors for lower-extremity motor or sensory deficits and surgical results of patients with spinal tuberculosis: A retrospective study of 329 patients

Abstract

Many studies about the characteristics of spinal tuberculosis (STB) have been published, but none has investigated the predictive factors for lower-extremity motor or sensory deficits (LMSD) in patients with STB.The objective of this study was to find early predictive factors for LMSD and evaluate surgical results of patients with STB.From 2001 through 2010, 329 patients with STB were treated in our department and surgical treatment was performed in 274 patients. The factors assessed included age, sex, duration of symptoms, worsening of illness, clinical symptoms, clinical signs, imaging characteristics, kyphotic angle, Oswestry disability index (ODI), and visual analogue scale (VAS) scores.Of the 329 patients studied, 164 presented with LMSD (the LMSD group), of which 93 patients (28.3%) had motor deficits and 177 patients (53.8%) had sensory disturbance. The other 165 patients were included in the control group (the No LMSD group). Using univariate logistic regression analysis, we found that the sex (P = 0.042), age (P = 0.001), worsening of sickness (P = 0.013), location (P = 0.009), and spinal compression (P = 0.035) were the risk factors of LMSD. Furthermore, the multivariate logistic regression analysis indicated that age (OR = 1.761, 95% CI: 1.227-2.526, P = 0.002), worsening of sickness (yes vs no: OR = 1.910, 95% CI: 1.161-3.141, P = 0.011), location (T vs C: OR = 0.204, 95% CI: 0.063-0.662, P = 0.008), and spinal compression (yes vs no: OR = 1.672, 95% CI: 1.020-2.741, P = 0.042) were independent risk factors of LMSD. Surgical treatment was performed in 274 patients. The kyphotic angle improved from 25.8 ± 9.1° preoperatively to 14.0 ± 7.6°, with a mean correction of 11.8 ± 4.0°, and a mean correction loss of 1.5 ± 1.8° at final visit. There were significant differences between the preoperative and the final ODI and VAS scores in both groups (P < 0.001 and P < 0.001, respectively).Spinal tuberculosis with cervical or lumbar vertebra involvement among the elder patients with a history of worsening of illness and spinal compression tended to cause LMSD, such as motor deficits or sensory disturbance. We should implement an appropriate treatment regimen to prevent exacerbation of STB such as operation, which can achieve thoroughness of debridement, adequate spinal stabilization, and better functional recovery.

Figure 1

A 23-year-old woman with T7–T11 tuberculosis, underwent transforaminal debridement, interbody fusion (iliac bone autograft), and posterior instrumentation. (A) Preoperative X-ray films of thoracic spine show destruction of the T9–T11 vertebrae. (B) Coronal and sagittal CT scans demonstrate tuberculosis cavities at T9–T11 and destruction of bone. (C) Preoperative sagittal MRI showing involvement of T7–T11 with collapse of the T9 and T10 vertebrae, paravertebral and epidural abscess with compression of the spinal cord. (D) Intraoperative picture showing the fixation of vertebrae and debridement of tuberculosis. (E, F) Postoperative X-ray and CT scans showing the posterior debridement, iliac bone autograft, and internal fixation. (G) X-ray films of thoracic spine show grafts union at the final follow-up of 24 months. CT = computed tomography, MRI = magnetic resonance imaging.

Figure 2

A 45-year-old woman with thoracolumbar spinal tuberculosis underwent transforaminal debridement, interbody fusion (iliac bone autograft), and posterior instrumentation. (A, B) Preoperative X-ray films and CT scan of spine show destruction of the T12–L1 vertebrae. (c) Preoperative MRI showing enhancements of the inflammatory vertebral bodies, tissue, and abscess. (D) X-ray showing the posterior debridement, bone graft, and internal fixation immediately after operation. (E, F) X-ray films and three-dimensional CT scans of thoracic spine show maintenance of the correction and solid fusion at the final follow-up of 30 months. CT = computed tomography, MRI = magnetic resonance imaging.