Tuberculosis of the spine--Prospective neurological and patient reported outcome study

Abstract

Objective: To prospectively investigate the rate of neurological recovery and patient reported outcome of tuberculosis (TB) spine patients following surgery at a tertiary referral hospital. TB spine remains a major cause of neurological impairment in the developing world fuelled by poor socio-economic conditions and HIV co-infection. Although numerous retrospective studies are available, there is a paucity of prospective data regarding rate of neurological improvement and patient reported outcome.

Methods: Twenty adult patients were prospectively recruited. The average age was 44.5 years. Half had co-existent HIV infection. All patients underwent decompressive surgery utilising a variety of anterior and posterior procedures. All received a minimum of 9 months TB medication. They were followed up at 4, 8, 12, 26 and 52 weeks post operatively. Neurological status was monitored by Nurick, mJOA and ASIA systems. Patient reported outcome was monitored by SF36 questionnaires at all-time points.

Results: All patients improved neurologically including 4 ASIA A's. By last follow up, 17 could walk as opposed to 5 pre-op. The Nurick average score improved from 5.5 to 1.9 and the mJOA lower limb score 1.8-5.5. The SF36 improved from 31 to 62 over the year with the biggest gains occurring after 3 months. This was confirmed in all domains except pain and social, which improved earlier.

Conclusions: There is a positive prognosis for neurological outcome in TB spine following a variety of surgical decompressive procedures and medical therapy. The majority of the recovery occurs after the 3 months post-operative mark.

Keywords: Prospective neurological patient; Reported outcome; Spine; Tuberculosis.