Severe Spinal Tuberculosis Challenges in Surgical Management
Aziz ur Rehman1, Sajjad ullah1, Muhammad idris khan1, Moath Ahmed Abdullah Abdullah2, Sulaiman Khan3
1 Khyber teaching hospital Peshawar
2 Institute of Public Health and Social Science-KMU
3 Hayatabad Medical Complex Peshawar.
Vol 16, Issue 02
Submission Date: 02/11/25 | Acceptance Date: 10/03/25 Publication Date: 25/05/26
CORRESPONDING AUTHOR: DR Aziz ur Rehman, FCPS Neurosurgery, Khyber Teaching Hospital.
Abstract
Background: Spinal tuberculosis can cause vertebral collapse, kyphosis, and neurological deficit. Chemotherapy remains the base treatment. Surgery is indicated when neurological compromise, instability, deformity, or abscess-related compression risk persists despite medical therapy. Surgical outcomes are reported for a cohort with severe spinal tuberculosis.
Methods: Retrospective observational study of 200 patients operated between July 2022 and October 2025 at the Department of Neurosurgery, Khyber Teaching Hospital, Peshawar. Surgical approaches included anterior, posterior, and combined procedures. Variables recorded included age, sex, residence, tuberculosis history, symptom duration, spinal level, lesion type, vertebrae involved, ASIA grade, VAS, ESR, CRP, Cobb angle, operative time, blood loss, hospital stay, mobilization time, complications, and recurrence.
Results: Mean age was 41.9 ± 23.7 years. Females were 108 (54.0%) and males were 92 (46.0%). Mean symptom duration was 27.5 ± 14.9 weeks. Cervical involvement was 60 (30.0%), thoracic 46 (23.0%), lumbar 48 (24.0%), and lumbosacral 46 (23.0%). Approaches were posterior 68 (34.0%), combined 67 (33.5%), and anterior 65 (32.5%). Instrumentation was used in 89 (44.5%). Neurological outcome was improved in 63 (31.5%), unchanged in 74 (37.0%), and worsened in 63 (31.5%). Wound infection occurred in 102 (51.0%) and recurrence in 90 (45.0%). Recurrence differed by approach (p = 0.047), and in adjusted analysis the combined approach showed lower odds of recurrence (Odds Ratio [OR] 0.40, 95% Confidence Interval [CI] 0.19 to 0.85, p = 0.016). Wound infection was independently associated with male sex (OR 2.31, 95% CI 1.20 to 4.44, p = 0.012) and instrumentation (OR 2.30, 95% CI 1.22 to 4.32, p = 0.010).
Conclusion: Surgical management produced variable neurological recovery in a severe cohort. High rates of wound infection and recurrence were the main barriers to durable benefit. Combined approaches showed lower recurrence odds after adjustment. Surgical treatment improved clinical status for a substantial proportion of patients.Keywords: spinal tuberculosis; surgical approach; neurological outcome; wound infection; recurrence; kyphosis.