RT Journal Article
SR Electronic
T1 Factors Affecting Neurological Deficits in Thoracic Tuberculous Spondylodiscitis
JF International Journal of Spine Surgery
JO Int J Spine Surg
FD International Society for the Advancement of Spine Surgery
SP 645
OP 651
DO 10.14444/8522
VO 17
IS 5
A1 Terdpong Tanaviriyachai
A1 Kongtush Choovongkomol
A1 Patchara Pornsopanakorn
A1 Sarut Jongkittanakul
A1 Urawit Piyapromdee
A1 Weera Sudprasert
YR 2023
UL http://ijssurgery.com//content/17/5/645.abstract
AB Background Thoracic spinal tuberculosis (TB) causes destruction of the spine and compression of the adjacent spinal cord. This study aimed to identify the risk factors for neurological deterioration in patients with thoracic spinal TB to guide decision-making regarding immediate surgery before the onset of weakness.Methods Demographic, clinical, laboratory, and radiologic (x-ray and magnetic resonance imaging) data of 115 patients with active thoracic spinal TB were retrospectively analyzed. Patients with neurological status categorized as Frankel grades A, B, or C (n = 71) were classified as the neurological deficit group, while those with neurological status categorized as Frankel grades D and E (n = 44) constituted the control group. Univariate and multivariate logistic regression analyses were used to predict the risk factors for neurological deficits.Results The mean patient age was 57.2 years. The most common lesion location was the distal thoracic region (T9-L1; 62.6%). Paradiscal involvement was the most common form of involvement (73%). In the univariate analysis, the significant risk factors associated with neurological worsening were overweight (body mass index [BMI] >25), C-reactive protein level > 20 mg/L, panvertebral involvement, loss of cerebrospinal fluid posterior to the cord, cord signal changes, and canal compromise. The multivariate analysis revealed that only BMI >25 (adjusted OR = 16.18; 95% CI 1.60–163.64; P = 0.018), cord signal changes (adjusted OR = 7.42; 95% CI 1.85–29.74; P = 0.005), and canal encroachment >50% ( adjusted OR = 51.86; 95% CI 5.53–486.24; P = 0.001) were independent risk factors for predicting the risk of neurological deficits.Conclusions Overweight (BMI >25), cord signal changes, and canal compromise >50% significantly predicted neurological deficits in patients with thoracic spinal TB. Prompt spinal surgery should be considered before progressive worsening of the neurological condition in patients with all of these risk factors.Clinical Relevance Predictive factors for neurological deficits in thoracic spinal TB were determined. Overweight, cord signal changes, and canal compromise >50% showed predictive value. These factors can help identify patients who require early surgical intervention.Level of Evidence 3.