Spinal Tuberculosis: Features and Early Predictive Factors of Poor Outcomes

Neutrophil-lymphocyte ratio: a correlation study of its effect on magnetic resonance imaging enhancement patterns in spinal parenchymal tuberculosis

OBJECTIVE

To explore the impact of the neutrophil-lymphocyte ratio (NLR) on magnetic resonance imaging (MRI) enhancement patterns in patients with spinal parenchymal tuberculosis.

METHODS

In this study, a retrospective analysis was conducted on 42 patients diagnosed for the first time with spinal parenchymal tuberculosis at Kunming Third People's Hospital between 2019 and 2024. They were divided into a homogeneous enhancement group and a ring enhancement group based on MRI characteristics and an analysis of their clinical presentations, imaging features and laboratory test results.

RESULTS

A total of 42 patients were included in the study, with 30 in the ring enhancement group and 12 in the homogeneous enhancement group. The ring enhancement group exhibited a significantly higher proportion of fever, night sweats and limb sensory/motor dysfunction compared with the homogeneous enhancement group (p < 0.05). For laboratory tests, the ring enhancement group showed remarkably elevated peripheral blood neutrophil counts and NLR, along with markedly reduced lymphocyte counts and proportions (p < 0.05). Additionally, the incidence of perilesional oedema was substantially higher in the ring enhancement group than in the homogeneous enhancement group (p < 0.05).

CONCLUSION

The NLR may serve as a potential indicator for assessing MRI enhancement patterns in spinal parenchymal tuberculosis, which is beneficial for identifying patients at different pathological stages of the disease. This study provides novel perspectives for clinical diagnosis and treatment while emphasising the need for further research on the application value of the NLR in tuberculosis.

Clinical efficacy of different surgical approaches in the treatment of thoracolumbar tuberculosis: a multicenter retrospective case-control study with a minimum 10-year follow-up

OBJECTIVE

To evaluate the long-term clinical efficacy of three different surgical approaches in treating thoracolumbar tuberculosis.

METHODS

A total of 176 patients with thoracolumbar tuberculosis, treated with open surgery at two hospitals, were retrospectively analyzed. Patients were stratified into three groups based on the surgical approach: anterior-only (AO), posterior-only (PO), and anterior-posterior combined (AP) approaches. Collected data encompassed operative duration, intraoperative blood loss, hospital stay length, complications, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI), American Spinal Injury Association (ASIA) classification, and radiographic measurements of segmental lordotic Cobb angles, correction angles, and correction rates.

RESULTS

The minimum duration of follow-up among all patients was 10 years. Postoperatively, all patients experienced a reduction in ESR and CRP, with normalization occurring within 3 months and sustained normal at the last follow-up. The AP group had a longer operative duration and higher intraoperative blood loss than the other two groups. The Cobb correction rates for AO, PO, and AP were (56.33±6.62)%, (72.82±5.66)%, and (74.45±5.78)%, respectively. The correction loss of Cobb angles for AO, PO, and AP were (2.85±1.01)°, (1.42±0.97)°, and (1.19±0.89)°, respectively. Patients in all groups showed significant improvement in VAS scores and ODI postoperatively, with no notable intergroup differences. The neurological recovery rates for the AO, PO, and AP groups were 84.62, 87.10, and 83.72%, respectively, while the complication rates were 12.73, 16.98, and 22.06%, respectively.

CONCLUSION

An anterior-only approach is recommended for cases with localized lesions and smaller angular deformities. For patients with multisegmental lesions and larger angular deformities, a posterior-only or anterior-posterior combined approach is advised, with a preference for the posterior-only approach.

Rehabilitation management of patients with spinal tuberculosis (Review)

Spinal tuberculosis (ST) is a serious condition and a global health concern, accounting for a significant portion of musculoskeletal tuberculosis cases. It can lead to sever spinal and neurological complications. The management of ST involves a multidisciplinary approach, including medical treatment, surgery and rehabilitation. Rehabilitation is crucial through the course of the disease's and is tailored for each stage according to the patients' complaints, and clinical and functional complications. In the case of neurological issues due to spinal compression, rehabilitation aims at overcoming bed confinement complications, involving mobilization techniques, strengthening exercises and related vesico-sphincter disorders (urodynamics, catheterizing). The role of rehabilitation for the management of pain in patients with ST is based on bracing (restricting movements and relieving the pressure on harmed structures), and analgesic physical means (electrical stimulation and massage techniques). Several rehabilitation options may be used to address musculoskeletal complications. Range of motion exercises, muscle strengthening, and posture and balance correction using sensory perception and proprioception techniques, are commonly involved. Cardiorespiratory reconditioning is required to improve respiratory function, walking ability and cardiovascular endurance. Ultimately, rehabilitation allows for the minimization of disability and the prevention of the loss of autonomy, particularly in elderly patients. The advantage of the rehabilitation approach is its multi-optional characteristics including physical therapy, occupational therapy, ergonomic advices and assistive equipment. Despite its crucial role, rehabilitation remains understudied in the management of ST. Thus, the present mini-review aimed to address the rehabilitation options for the clinical features and complications of ST, according to the course of the disease.