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. Jul-Aug 2019;53(4):525-532.
doi: 10.4103/ortho.IJOrtho_692_17.

A Prospective Study of Clinicoradiologic-Urodynamic Correlation in Patients With Tuberculosis of the Spine

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Free PMC article

A Prospective Study of Clinicoradiologic-Urodynamic Correlation in Patients With Tuberculosis of the Spine

Roop Singh et al. Indian J Orthop. .
Free PMC article

Abstract

Introduction: Involvement of spinal cord in spinal tuberculosis (TB) has been associated with bladder disturbances on which literature is scarce. The present study aimed at evaluating the urodynamic profile, its correlation with clinical and radiological features, and the prognosis with treatment in these patients.

Materials and methods: Thirty patients of spinal TB were prospectively evaluated clinically, radiologically, and urodynamically in this single center prospective study. All patients underwent urodynamic assessment at presentation; and those with bladder dysfunction on initial urodynamics were followed with sequential testing at 3, 6, and 12 months.

Results: Patients were divided into two groups on the basis of the absence (Group 1, n = 14) or presence (Group 2, n = 16) of bladder dysfunction. The magnitude of deformity (P = 0.011), sensory deficit (P = 0.025), and tenderness (P = 0.030) at presentation was found to be significantly more in Group 2 and involvement of posterior elements, reduction in disc height, endplate erosion, and nerve root were significantly higher. The initial urodynamic assessment showed delayed sensations in 23.3% and early sensations in 13.3%, respectively; decreased bladder compliance in 3.33%; underactive detrusor in 16.6%, and overactive in 13.3% of cases. The sphincter was dyssynergic in 13.3% of cases. Statistically significant (P < 0.001) improvement in sensory parameters of bladder, detrusor contractility, and compliance with treatment was observed. Thirteen (81.3%) patients of Group 2 showed overall improvement on serial urodynamics after chemotherapy. Patients with bladder disturbances had poorer functional recovery at 6 and 12 months.

Conclusion: Significant bladder comorbidity is associated with spinal TB and its presence can be recognized as a poor prognostic factor. Urological morbidity is strongly linked to the nerve root and posterior element involvement; reduction in disc height; and end plate erosion. Clinical/neurological improvement correlates with marked radiological and urological improvement.

Keywords: Correlation; magnetic resonance imaging; spinal tuberculosis; urodynamic study.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Plain radiographs of the patient with tubercular spondylitis (L2–L3) with neurological involvement (American spinal injury impairment scale B) and bladder comorbidity at presentation, 6 months, and 12 months. Initial X-rays show typical paradiscal involvement of two vertebrae with disc involvement and endplate destruction (a) 6 months (b) and 12 months (c) X-rays show healing with endplate sclerosis and reduced disc height
Graph 1
Graph 1
Pattern of vertebral involvement on different followup times
Graph 2
Graph 2
End plate erosion at initial and 12 months in both groups
Graph 3
Graph 3
Bone marrow edema at initial and 12 months in both groups
Graph 4
Graph 4
Reduction in disc height initial and 12 months in both groups
Graph 5
Graph 5
Posterior element involvement at initial and 12 months in both groups
Graph 6
Graph 6
Extradural spread at initial and 12 months in both groups
Graph 7
Graph 7
Various components of intracanalicular spread at various followup visits in the cohort
Figure 2
Figure 2
T2-weighted magnetic resonance imaging images of the same patient. Initial magnetic resonance imaging shows paradiscal involvement of 2 vertebrae with end plate erosion, bone marrow edema, sub ligamentous spread and reduction in disc height. (a) At 6 months edema and sub ligamentous collection are absent; and disc space has further narrowed. (b) At 12 months completely healed tuberculosis with disc space narrowing (c)
Figure 3
Figure 3
Urodynamic study of the same patient. Patient had early sensations, normal compliance, overactive detrusor and dyssynergic sphincter initially. At 12 months patient improved neurologically. Urodynamically sensations remained early, normal compliance, detrusor was underactive, and sphincter became synergic
Graph 8
Graph 8
Bladder sensation at various followup visits
Graph 9
Graph 9
Compliance at various follow up visits
Graph 10
Graph 10
Detrusor activity at various followup visits
Graph 11
Graph 11
Sphincter activity at various followup visits

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