It’s Never Too Late: Neurological Outcome of Delayed Decompression in Tuberculosis of Spine

Abstract

Study Design: Retrospective observational study. Objective: To study the neurological recovery in patients with progressive neurological deficit undergoing delayed decompression and fixation in tuberculosis of spine. Methods: Retrospective analysis of 50 cases with thoracolumbar tuberculosis of spine, undergoing posterior decompression and instrumentation was done. Parameters like time interval between appearance of neurological deficit to decompression surgery, maximal spinal cord compression, neurology on admission, presence of drug resistance, and number of vertebrae involved were evaluated. The subjects were divided into 2 groups depending on neurological improvement measured with LEMS (Lower Extremity Motor Score) at the end of 1-year follow-up. Results: The mean LEMS score on admission was 27.72 (SD 12.88), which improved to 40.80 (SD 10.46) at the end of 1 year ( P < .001). A total of 26 (52%) subjects were categorized into “Satisfactory” outcome (LEMS >10) group and remaining 24 subjects formed the “nonsatisfactory” outcome group. The median time interval between the appearance of neurological deficit and decompression surgery was 23.50 days in the satisfactory group and 29.50 days ( P = .110) in the nonsatisfactory group. Maximal spinal cord compression was 0.370 in satisfactory group and 0.357 in nonsatisfactory group ( P = .754). The mean preoperative LEMS score was 34.62 in the satisfactory outcome group while that in the nonsatisfactory outcome group was 20.25 ( P < .001). Conclusion: There is significant scope for neurological improvement even after delayed decompression and fixation in cases of tuberculosis of spine with progressive neurological deficits. Preoperative neurological status was found to be the most significant determinant of postoperative neurological outcome.