Recovery Of Nerve Function In Patients With Spinal Tuberculosis After Operation

Objective: To investigate whether the neurological function can recover after operation,how long it can recover,and the factors affecting the recovery of neurological function by retrospective analysis of the neurological function of patients with spinal tuberculosis before and after operation.Methods: The clinical data of 52 patients with spinal tuberculosis complicated with neurological deficit who underwent surgery in our hospital from January 2015 to June 2021 were collected.Among them,there were 19 males and 33 females,aged 19 ～ 84 years(52.00 ± 17.00).According to Frankel classification,there were 5 cases of grade B,25 cases of grade C and 22 cases of grade D,including 9 cases of cervical vertebra,27 cases of thoracic vertebra,14 cases of thoracolumbar segment,2 cases of cervicothoracolumbar multiple segments.18 cases underwent anterior tuberculosis debridement and bone graft fusion and internal fixation,28 cases underwent posterior tuberculosis debridement and bone graft fusion and internal fixation,5 cases underwent anterior debridement and bone graft posterior fusion and internal fixation combined with surgery,and 1 case underwent posterior simple lesion debridement.All patients were regularly treated with oral quadruple anti-tuberculosis drugs for 12 to 18 months after surgery.Results: After a follow-up of 12 to 90 months,40 patients had final neurological recovery to grade E(grade E group),with an average recovery time of 2.83 months,and 12 patients had neurological recovery to grade D(grade D group),with an average recovery time of 11.15 months.The rate of complete recovery of neurological function was 87.88% in patients with neurological impairment for less than 1 month before surgery,68.75% in patients with neurological impairment for 1 to 3months,and 76.9% in 52 patients with neurological impairment for more than 3 months at the last follow-up.The results of univariate analysis showed that the days of preoperative paralysis in grade E group were significantly less than those in grade D group(P < 0.05),the number of spinal cord signal changes in grade E group was significantly less than that in grade D group(P < 0.05),and the number of vertebral destruction in grade E group was significantly less than that in grade D group(P < 0.05).The results of multivariate analysis showed that preoperative paralysis days and spinal cord signal changes were independent risk factors affecting postoperative neurological recovery(P < 0.05).Conclusion:Most of the patients with spinal tuberculosis complicated with neurological impairment can completely recover their neurological function after regular antituberculosis drugs combined with surgical treatment.The length of days of paralysis before surgery and the change of spinal cord signal before surgery are risk factors affecting the recovery of postoperative neurological function.Therefore,early diagnosis and active treatment of spinal tuberculosis complicated with neurological impairment should be realized.