Evaluation of prognostic factors in medically treated patients of spinal tuberculosis

Abstract

This study was aimed to determine the prognostic factors in medically treated patients of spinal tuberculosis. In this longitudinal observational study, from July 2010 to December 2011, 70 consecutive patients (40 males and 30 females) spinal tuberculosis were enrolled. Diagnosis of spinal tuberculosis was based on characteristic clinical and neuroimaging features. Diagnosis was histopathologically and/or bacteriologically verified. Patients received antituberculous treatment as per World Health Organization guidelines and were followed for 6 months. Disability was evaluated with modified Barthel index (MBI). Outcome was defined as good (MBI > 12) and poor (MBI ≤ 12). Various clinical and neuroimaging parameters, likely to affect the outcome, were analyzed using univariate and multivariate analysis. After 6 months, 45 patients had a good outcome, while 25 patients had a poor outcome. On univariate analysis, duration of illness >6 months (OR 0.062, CI 0.018-0.212), bladder involvement (OR 0.102, CI 0.033-0.317), spinal deformity (OR 0.050, CI 0.013-0.196), spastic paraparesis (OR 0.572, CI 0.190-1.723), and flexor spasms (OR 0.077, CI 0.021-0.280) were found as important clinical predictors of poor outcome. Involvement of more than 2 vertebrae (OR 0.095, CI 0.028-0.328), complete collapse (OR 0.072, CI 0.022-0.241), cord compression (OR 0.025, CI 0.003-0.204), spinal extension of the abscess (OR 0.044, CI 0.005-0.350), and thick/septate abscess wall (OR 0.062, CI 0.016-0.240) were the neuroimaging parameters associated with poor prognosis. However, on multivariate analysis, duration of illness >6 months (Exp-b 0.086, CI 0.019-0.378), cord compression (Exp-b 0.035, CI 0.003-0348), and spinal extension of the abscess (Exp-b 0.109, CI 0.017-0.91) were significant. Medical management results in clinical improvement in a majority of the patients of spinal tuberculosis. Duration of illness >6 months, cord compression, and spinal extension of abscess are associated with poor outcome.

Demographics of tuberculosis of spine and factors affecting neurological improvement in patients suffering from tuberculosis of spine: a retrospective analysis of 312 cases

“…[12][13][14] Although there are limited studies regarding factors affecting neurological recovery in tuberculosis of spine, delay in starting treatment, cord compression, spinal extension of abscess and involvement of more than two vertebras were considered bad prognostic factors in medically treated patients of spinal tuberculosis according to one study. 15 Other studies have stated young age and surgical intervention as a favorable prognostic factor. 16,17 The purpose of the study was to study demographics of tuberculosis of spine and analyze factors that might affect neurological improvement in patients suffering from tuberculosis of spine.…”

Performance of the deep convolutional neural network based magnetic resonance image scoring algorithm for differentiating between tuberculous and pyogenic spondylitis

“…Many cases of inappropriate treatment because of delayed diagnosis or misdiagnosis have been reported. Since it takes a long time for the treatment effect to appear, delayed diagnosis sometimes leads to an increased duration of hospitalization or increased need for surgery due to neurological deficits or spinal deformity 2,22 . Moreover, the relatively lower incidence of tuberculous spondylitis could increase the risk of misdiagnosis by less-experienced clinicians and radiologists.…”

“…Because rapid anti-tuberculosis treatment can prevent future disability 2 , it is important to differentiate between tuberculous and pyogenic spondylitis, which are the most common causes of infectious spondylitis. As magnetic resonance (MR) imaging is the most effective method for diagnosing infectious diseases of the spine, because of its superior soft tissue contrast, there have been various studies on differentiating between tuberculous and pyogenic spondylitis using MR imaging 3–6 .…”

Outcome assessment in conservatively managed patients with cervical spine tuberculosis

“…In this study, significant spinal cord compression by granulation tissue resulted in severe disabilities and was associated with poorer outcome. 17 Cervical spinal cord lesions often cause severe neurologic deficit because the cervical spinal canal is small in relation to the diameter of the cervical spinal cord. The proposed mechanisms responsible for neurologic manifestations in cervical spine tuberculosis are as follows: local inflammatory changes, cord swelling, vasculitis and ischemia in spinal cord parenchyma, subluxation of the vertebrae, tuberculous abscess compressing over the spinal cord or nerve root, and disc herniation.…”

“…18 The patients showing a relatively preserved cord with evidence of edema/myelitis with fluid collection predominantly in the extradural space on MRI recover on medical treatment, whereas patients with extradural compression of mixed or granulomatous nature showing encasement of the spinal cord may be considered for surgery. 17 Four of our patients were subjected to surgery. Three patients had not responded to medical treatment while one developed a swallowing problem.…”