Preoperative Motor and Sensory Dysfunction as Predictors of Permanent Neurological Deficit in Spinal Tuberculosis: A Retrospective Cohort Study.

BACKGROUND

Spinal tuberculosis (TB) remains a leading cause of permanent neurological deficit in endemic regions. Identifying preoperative factors associated with poor neurological outcomes could inform surgical decision-making, but high-quality predictor data are limited.

METHODS

We retrospectively analyzed 27 consecutive adult patients who underwent surgical treatment for spinal TB at a tertiary neurosurgical center between January 2018 and December 2022. Permanent neurological deficit was defined as persistent motor weakness (Medical Research Council [MRC] grade ≤4) or sensory impairment at a minimum of 12 months postoperatively. Univariable associations were assessed using chi-square or Fisher's exact tests, with prevalence ratios (PR) and 95% confidence intervals (CIs).

RESULTS

Fifteen patients (55.6%) developed permanent neurological deficit. Two preoperative variables were significantly associated with poor outcomes: severe motor dysfunction (MRC 0-3) (PR 3.82, 95% CI 1.08-13.58; Fisher's exact test, p = 0.007) and diminished or absent sensation (PR 2.55, 95% CI 1.08-6.03; Fisher's exact test, p = 0.021). Cervical-thoracic involvement showed a non-significant trend toward worse outcomes (PR 2.20, 95% CI 0.93-5.18; Fisher's exact test, p = 0.057). Age, sex, comorbidities, sphincter dysfunction, number of vertebral levels affected, and radiological features including epidural compression were not significantly associated with permanent deficit.

CONCLUSIONS

Preoperative motor and sensory status are the strongest available predictors of permanent neurological deficit in patients undergoing surgery for spinal TB. These findings support early identification and prioritization of patients with severe preoperative neurological compromise. Larger multicenter studies are needed to develop and externally validate quantitative risk prediction tools.