Functional Outcomes in Spinal Tuberculosis: A Review of the Literature

Abstract

Spinal tuberculosis often leads to neurological deficit and subsequent deterioration in functional outcomes. This review assesses the recent evidence on functional outcomes in spinal tuberculosis, highlighting functional recovery, assessment tools for functional measures, and associative factors for functional recovery. Using PubMed, a literature search was done using the terms "spinal tuberculosis," "tuberculous spondylitis," "tuberculous spondylodiscitis," and "functional outcome" for original articles published between January 2010 and December 2019. A total of 191 search results were found. Detailed screening showed that 19 articles met the eligibility criteria: 13 of these focused on surgical methods, four on conservative management, and two on rehabilitation approaches. The outcome measures used for functional assessment were the Oswestry Disability Index (11 articles), Japanese Orthopaedic Association score (n=3), modified Barthel Index (n=2), Functional Independence Measure (n=2), and 36-item Short-Form Health Survey (n=1). Functional outcome was mainly affected by pain, spinal cord compression, and inpatient rehabilitation. No significant difference in functional outcome was found between conservative management and surgery for cases with uncomplicated spinal tuberculosis. Most studies focused on surgery as the mode of treatment and used pain-related functional measures; however, these assessed functional limitations secondary to pain, and not neurological deficits. Further studies may consider examining functional outcomes in spinal tuberculosis by utilizing spinal cord-specific functional outcome measures, to evaluate outcome measures as a prognostic tool, and to measure functional outcomes from specific rehabilitation interventions.

Comparative Efficacy of Traditional Conservative Treatment and Ct-guided Local Chemotherapy for Mild Spinal Tuberculosis

“…Bhojraj et al [18] reported more than 98% spinal tuberculosis patients can be cured by simple chemotherapy and avoided surgery. No signi cant difference in functional outcome was found between conservative management and surgery for cases with uncomplicated spinal tuberculosis [19].…”

Study on the expression level of NF-κB and clinical evaluations in spinal tuberculosis patients

“…But the most complicated form is central nervous system disease, which has severe consequences for the patient if not diagnosed or treated late. Sometimes, due to the ambiguity and unknown clinical symptoms, the diagnosis is made late or even, in some cases, is made incorrect (2). Therefore, clinical awareness about this disease should always be considered to reduce patients suffering from the dangerous consequences (3).…”

“…Its involvement occurs in various forms, such as spinal cord tuberculosis, arachnoiditis, radiculomyelitis, and syringomyelia without vertebral involvement. These complications, which can be a complication of meningitis, are rare and dangerous and can only lead to complete recovery if diagnosed and treated early (2). Tuberculosis can damage enzymes, DNA, and other macromolecules and induce oxidative stress responses.…”

Clinical, Biochemical and Radiological Factors Affecting the Prognosis of Neurological Deficit Improvement in Spinal Tuberculosis Patients at Hospitals of Sabah

“…The number of reported cases has been rising ever since and its incidence is highest in developing countries. It accounts for about 2 -15%% of cases of TB, representing the most common target of osteoarticular TB (Snider et al, 2017;Yong et al, 2020). In Malaysia, there have been 25,713 cases recorded for tuberculosis in 2018 alone with an estimated incidence rate of 92 per 100000 cases.…”

“…To identify factors that might predict a poor functional outcome recovery in spinal tuberculosis patients. These patients may require more aggressive rehabilitation to give them a better chance at achieving their best functional outcome recovery (Yong, 2020).…”