Prognostic factors affecting the functional recovery in spinal tuberculosis patients with neurological deficit

Abstract

This study is aimed to determine the factors associated with the functional recovery in spinal tuberculosis patients with neurology deficits. To assess clinical, biochemical and radiological parametersin relation to the prognostic factors. This cross-sectional study from July 2017 to June 2018, patients presenting to 3 hospitals in Sabah, with significant neurology fulfilling the inclusion criteria were enrolled. Diagnosis of spinal tuberculosis was determined either by clinical radiological factors and confirmed with histopathology, microbacteriology and immunoassay. Patients with significant neurology received standard treatment protocol according to the middle pathway regime, receiving anti tuberculosis for the first 3 weeks and were subjected to surgery if there were no improvement. Modified Barthel Index (MBI) was used to asses functional outcome, scores were taken before and after treatment and with improvement of 4 points or a total of more than 12 were considered as good outcome. After a year, 146 patients (65.1%) had good functional recovery and 78 patients had no significant improvement. On univariate analysis, there was no significant correlation with age (p>0.45), duration of symptoms (p>0.68), CRP (p>0.76), WCC (p>0.99), and presence of soft tissue collection (p>0.21) with functional outcome. High ESR (p<0.008) and thoracolumbar lesions are associated with a poor functional recovery (p<0.033). In conclusion, higher ESR values, numbers of vertebrae involved, and thoracolumbar lesions are associated with poor functional outcome in spinal tuberculosis patients.