Comparison of the Efficacy and Prognosis of Different Treatment Strategies for Spinal Tuberculosis Patients Undergoing Vertebral Augmentation Surgery by Mistake.

OBJECTIVE: Early diagnosis of spinal tuberculosis remains challenging, and inappropriate percutaneous vertebral augmentation can aggravate lesions and worsen clinical symptoms. Relevant clinical evidence on subsequent standardized management remains limited. This study aimed to investigate the clinical efficacy and prognostic outcomes of different treatment strategies in patients with spinal tuberculosis following inappropriate percutaneous vertebral augmentation, and to analyze the clinical characteristics of the patients and provide clinical data for the differential diagnosis of spinal tuberculosis.

METHODS: The clinical data of 53 patients with spinal tuberculosis who underwent vertebral augmentation between January 2012 and January 2024 were retrospectively analyzed. There were 26 males and 27 females, with a mean age of 70.33 ± 5.88 years (range 53-86 years). Thirty-one patients had thoracic tuberculosis, and 22 had lumbar tuberculosis. According to the ASIA Impairment Scale, 7 patients were grade B, 15 were grade C, 24 were grade D, and 7 were grade E. At admission, 52 patients had elevated erythrocyte sedimentation rates (ESRs) and C-reactive protein (CRP) levels, 36 had positive T-SPOT results, and 1 patient had a normal ESR and CRP level and negative T-SPOT result. Twenty-seven patients had single-vertebral involvement, and 26 had multiple-vertebral involvement. Patients were divided into two groups, and a retrospective cohort comparative analysis was conducted: Surgical group (35 patients) received posterior spinal canal decompression, bone graft fusion, and internal fixation; conservative group (18 patients) received non-surgical treatment. Outcomes included ESR, CRP level, VAS score, ASIA grade, and MBI score. Enumeration data were analyzed with the χ2 test for intergroup differences in proportions. Normally distributed continuous data were compared using the independent samples t-test. Non-normally distributed continuous data were analyzed using the Mann-Whitney U test. Paired comparisons were performed using the Wilcoxon signed-rank test. Repeated measures data were analyzed using the rank-sum test.

RESULTS: The follow-up period ranged from 18 to 36 months. Early postoperative increases in the ESR and CRP level were significantly greater in the surgical group than in the conservative group, but inflammatory marker levels normalized within 3-6 months in both groups. Before treatment, there were no significant differences in the ESR, CRP level, VAS score, MBI, or ASIA grade between the groups (all p > 0.05). At 3 months and at the final follow-up, the ESR, CRP level, and VAS score decreased significantly and the MBI and ASIA grades improved significantly in both groups (all p < 0.05). The MBI was significantly better in the surgical group at 3 months (p < 0.05). At the final follow-up, no significant differences were found between the groups in any index (all p > 0.05).

CONCLUSION: This retrospective cohort study shows that compared with conservative treatment, surgical treatment results in faster symptomatic and functional recovery in patients with neurological compression after mismanaged vertebral augmentation for spinal tuberculosis. For patients without significant neurological compression or those who are unfit for surgery, conservative treatment achieves satisfactory long-term efficacy, although the recovery time is longer. Long-term outcomes are comparable between the two strategies.