Original Article

Predicting neurological deficit in patients with spinal tuberculosis – A single-center retrospective case-control study

¹ Senior Resident, AIIMS Rishikesh, 249203 Rishikesh, Uttarakhand, India
² Department of Orthopaedics, AIIMS Rishikesh, 249203 Rishikesh, Uttarakhand, India
³ Assistant Professor, AIIMS Rishikesh, 249203 Rishikesh, Uttarakhand, India
⁴ Additional Professor, Consultant Spine Surgeon, AIIMS Rishikesh, 249203 Rishikesh, Uttarakhand, India

^* Corresponding author: pankaj.orth@aiimsrishikesh.edu.in, pankajkandwal27@gmail.com

Received: 16 December 2020
Accepted: 26 January 2021

Abstract

Background: Identifying the risk factors for the neurological deficit in spine tuberculosis would help surgeons in deciding on early surgery, thus reducing the morbidity related to neurological deficit. The main objective of our study was to predict the risk of neurological deficit in patients with spinal tuberculosis (TB). Methods: The demographic, clinical, radiological (X-ray and MRI) data of 105 patients with active spine TB were retrospectively analyzed. Patients were divided into two groups – with a neurological deficit (n = 52) as Group A and those without deficit (n = 53) as Group B. Univariate and multivariate logistic regression analysis was used to predict the risk factors for the neurological deficit. Results: The mean age of the patients was 38.1 years. The most common location of disease was dorsal region (35.2%). Paradiscal (77%) was the most common type of involvement. A statistically significant difference (p < 0.05) was noted in the location of disease, presence of cord compression, kyphosis, cord oedema, loss of CSF anterior to the cord, and degree of canal compromise or canal encroachment between two groups. Multivariate analysis revealed kyphosis > 30° (OR – 3.92, CI – 1.21–12.7, p – 0.023), canal encroachment > 50% (OR – 7.34, CI – 2.32–23.17, p – 0.001), and cord oedema (OR – 11.93, CI – 1.24–114.05, p – 0.03) as independent risk factors for predicting the risk of neurological deficit. Conclusion: Kyphosis > 30°, cord oedema, and canal encroachment (>50%) significantly predicted neurological deficit in patients with spine TB. Early surgery should be considered with all these risk factors to prevent a neurological deficit.