Surgical management and clinical outcome of cervical, thoracic and thoracolumbar spinal tuberculosis in a mideuropean adult population
Authors: Kilinc Fatma , Setzer Matthias , Behmanesh Bedjan , Jussen Daniel , Geßler Florian , Prinz Vincent , Czabanka Marcus 
Published: January 2023

Abstract
Objective Spinal tuberculosis, known as Pott´s disease, is a rare but serious clinical condition which can lead to severe deformity and neurological complications. The majority of cases occur in population-dense developing countries like Africa or India, but due to globalization it is no longer a disease limited to developing nations. Thus it should be considered in patients with persistent back pain, who are at high risk, such as migrant population and immunocompromised patients. Nevertheless spinal tuberculosis remains in Germany a rarity and still a difficult diagnosis. Here we analyzed patients with Pott´s disease treated at our neurosurgical department supplying medical care for a mideuropean metropolitan region.
Methods Patients with cervical, thoracic and thoracolumbar spinal tuberculosis between 2014 and 2022 were retrospectively analyzed. According to the infected anatomic segment, patients were assigned in one of three groups. All patients were evaluated clinically using the visual analog scale (VAS). American Spinal Injury Association (ASIA) impairment scale was used for assessment of neurological status. Surgery was performed when neurological deficit due to mechanical compression, deformity, instability, severe pain, necrotic bone or failure to respond to anti-tuberculous treatment were observed. Long term follow-up as well as complications related to surgery were recorded and analyzed.
Results We identified 34 patients with spinal tuberculosis who underwent surgical treatment. All included patients had an immigrat background. In the cervical spinal tuberculosis group, there were 15 cases (46.9 %) with a mean age of 31.6+/-12 years. In 13 cases (86.7%) treatment consisted of spinal instrumentation. For two patient surgical debridement of the infected vertebrae and disc material and fusion was performed.
In the thoracic spinal tuberculosis group, there were 10 cases (29.4%) with a mean age of 37.7+/-16 years. The treatment was performed by dorsolateral spinal instrumentation.
In the thoracolumbar spinal tuberculosis group, there were 9 cases (26.4%) with a mean age of 44.1 +/-21 years. In five cases dorsolateral spinal instrumentation and in three cases only dorsal instrumentation was performed. The mean follow-up time was 47 months (range 6-96 months).
All included patients demonstrated clinical healing of tuberculosis infection. Bony fusion was achieved in 94.1 % with no loosening or breakage of internal fixation. In all three groups, the VAS pain score at 8 weeks after operation and at the most recent follow-up were lower than the preoperative level. One patient in the first group and one patient in the third group relapsed after operation. A second surgery was necessary. In eight cases (23.5%) neurological impairment (ASIA D) and in one case (2.9%) ASIA C was described, which regressed completely (ASIA E).
Conclusion Our results highlight the role of early surgery in the management of spinal tuberculosis. Patients with chronic back pain, immigration background and/or neurological deficit spinal TB should be considered as a differential diagnosis. Aggressive diagnosis of spinal TB is necessary and combined surgical intervention and medical treatment is associated with a favorable outcome.