Correlation between Gibbus and Neurological Status in Patients with Tuberculous Spondylitis and its impact after Operative Intervention

Lubna Egypti, Agus Hadian Rahim, Ahmad Rizal Ganiem, Ahmad Ramdan, Sofiati Dian

Abstract


Background: Tuberculous (TB) spondylitis is a chronic infectious disease associated with Mycobacterium tuberculosis that affects the spine. This disease is a challenging disease to treat due to its serious complications and high morbidity rate. Neurological deficits and spinal deformities that can occur along with gibbus are some of the most common complications. Early diagnosis and treatment are essential to cure this disease, with the administration of anti-TB drugs and operative intervention. This study aimed to analyze the correlation between gibbus and neurological status as well as the impact of operative intervention on the degree of gibbus and neurological status.

Methods: This was an observational-analytic study with a cross-sectional design on 32 medical records of TB spondylitis patients who underwent operative intervention from January 2018 to December 2021 at Dr. Hasan Sadikin General Hospital. Gibbus determined by x-ray analysis and neurological status determined by the American Spinal Injury Association (ASIA) impairment scale (AIS) were examined before and after the intervention. The sample was chosen based on consecutive sampling. All data collected was tested using Spearman's correlative analysis, paired t-test, and Wilcoxon sign-rank test with a p-value <0.05 considered statistically significant.

Results: There was a significant correlation between gibbus and neurological status-AIS (r=-0.708; p<0.05); and a significant positive impact of operative intervention on the degree of gibbus (p<0.05) and neurological status-AIS (p<0.05).

Conclusion: There is a correlation between gibbus and neurological status-AIS. In addition, operative intervention also has a significant positive impact on the degree of gibbus and AIS, resulting in good clinical and radiological outcomes.


Keywords


American Spinal Injury Association (ASIA) impairment scale, gibbus, neurological status, TB spondylitis

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References


  1. World Health Organization. Global tuberculosis report 2021. Geneva: World Health Organization; 2021.
  2. World Health Organization. Global tuberculosis report 2020. Geneva: World Health Organization; 2020.
  3. Rajasekaran S, Soundararajan DCR, Shetty AP, Kanna RM. Spinal tuberculosis: current concepts. Global Spine J. 2018;8(4 Suppl):96S–108S.
  4. Jain AK, Rajasekaran S, Jaggi KR, Myneedu VP. Tuberculosis of the spine. J Bone Joint Surg Am. 2020;102(7):617–28.
  5. Hadian RN, Prasetia R, Faried A. Correlation between degree of gibbus angulation, neurological deficits, and pain in spondylitis tuberculosis patients. IJIHS. 2017;5(2):80–3.
  6. Issack PS, Boachie-Adjei O. Surgical correction of kyphotic deformity in spinal tuberculosis. Int Orthop. 2012;36(2):353–7.
  7. Pan M, Ge J, Li Q, Li S, Mao H, Meng B, et al. Percutaneous vertebral augmentation in special Genant IV osteoporotic vertebral compression fractures. J Orthop Translat. 2019;20:94–9.
  8. Gokce A, Ozturkmen Y, Mutlu S, Gokay N, Tonbul M, Caniklioglu M. The role of debridement and reconstruction of sagittal balance in tuberculous spondylitis. Indian J Orthop. 2012;46(2):145–9.
  9. Roberts TT, Leonard GR, Cepela DJ. Classifications in brief: American Spinal Injury Association (ASIA) impairment scale. Clin Orthop Relat Res. 2017;475(5):1499–504.
  10. Agradi P, Hidajat NN, Ramdan A. Effect of preoperative anti tuberculosis drug administration duration on tuberculous spondylitis surgical treatment outcomes. J Anestesi Perioper. 2020;8(1):9–16.
  11. Alavi SM, Sharifi M. Tuberculous spondylitis: risk factors and clinical/paraclinical aspects in the south west of Iran. J Infect Public Health. 2010;3(4):196–200.
  12. Lin CY, Chen TC, Lu PL, Lai CC, Yang YH, Lin WR, et al. Effects of gender and age on development of concurrent extrapulmonary tuberculosis in patients with pulmonary tuberculosis: a population based study. PLoS One. 2013;8(5):e63936.
  13. Ismiarto AF, Tiksnadi B, Soenggono A. Young to middle-aged adults and low education: risk factors of spondylitis tuberculosis with neurological deficit and deformity at Dr. Hasan Sadikin General Hospital. Althea Med J. 2018;5(2):69–76.
  14. Hoffmann R, Lutz SU. The health knowledge mechanism: evidence on the link between education and health lifestyle in the Philippines. Eur J Health Econ. 2019;20(1):27–43.
  15. Al Mayahi ZK, Al-Aufi I, Al Ghufaili B, Al Balushi Z, Al Mughazwi Z, Mohammed E, et al. Epidemiological profile and surveillance activity of tuberculosis in South Batinah, Oman, 2017 and 2018. Int J Mycobacteriol. 2020;9(1):39–47.
  16. Marais BJ, Hesseling AC, Cotton MF. Poverty and tuberculosis: is it truly a simple inverse linear correlation? Eur Respir J. 2009;33(4):943–4.
  17. Garg RK, Somvanshi DS. Spinal tuberculosis: A review. J Spinal Cord Med. 2011;34(5):440–54.
  18. Kementerian Kesehatan Republik Indonesia. Pedoman nasional pelayanan kedokteran (PNPK) tata laksana tuberkulosis. Jakarta: Kementerian Kesehatan Republik Indonesia; 2019.
  19. Subramani S, Shetty AP, Kanna RM, Shanmuganathan R. Ossified ligamentum flavum causing neurological deficit above the level of post-tuberculous kyphotic deformity. J Clin Orthop Trauma. 2017;8(2):174–7.
  20. Deng Y, Lv G, An HS. En bloc spondylectomy for the treatment of spinal tuberculosis with fixed and sharply angulated kyphotic deformity. Spine (Phila Pa 1976). 2009;34(20):2140–6.
  21. Zeng Y, Wu W, Lyu J, Liu X, Tan J, Li Z, et al. Single-stage posterior debridement, decompression and transpedicular screw fixation for the treatment of thoracolumbar junction (T12-L1) tuberculosis with associated neurological deficit: A multicentre retrospective study. BMC Musculoskelet Disord. 2019;20(1):95.
  22. Yin XH, Liu SH, Li JS, Chen Y, Hu XK, Zeng KF, et al. The role of costotransverse radical debridement, fusion and postural drainage in the surgical treatment of multisegmental thoracic spinal tuberculosis: a minimum 5-year follow-up. Eur Spine J. 2016;25(4):1047–55.
  23. Yang H, Hou K, Zhang L, Zhang X, Wang Y, Huang P, et al. Minimally invasive surgery through the interlaminar approach in the treatment of spinal tuberculosis: A retrospective study of 31 patients. J Clin Neurosci. 2016;32:9–13.




DOI: https://doi.org/10.15850/amj.v11n1.2991

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