Pengfei Shao,* Yushan Wang,* Mingjie Dong, Hao Fan, Yingjie Gao, Yu Gao, Zhaoyang Hao, Jia Lv, Junjun Bai, Zhuangzhuang Wu, Yi Feng

Department of Orthopedics, The Second Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Yi Feng, Department of Orthopedics, The Second Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China, Email fengyi160@126.com

Purpose: Unexplained neurological dysfunction often occurs in patients after spinal tuberculosis(STB) surgery; therefore, this study aimed to analyze the causes of this dysfunction from the perspectives of the patient’s preoperative inflammatory state, carrier bacterial state, and increased degree of autoimmunity.
Patients and Methods: We collected 247 patients with STB and 270 patients with degenerative diseases of the spine admitted from May 2015 to December 2024 at the Second Hospital of Shanxi Medical University. According to the exclusion criteria, 132 patients for each disease were included in this study. All patients with spinal STB underwent one-stage posterior lesion removal. We used the ASIA score to assess patients’ neurological function and pain levels before and after surgery. We also compared the patients’ pre- and postoperative changes in relevant inflammatory indicators, such as the ESR and PCT.
Results: Postoperatively, one patient developed paraplegia with an ASIA grade of A; 29 patients developed incomplete paraplegia with an ASIA score of grade B in 5 patients, grade C in 7 patients, and grade D in 17 patients. In the damaged group, LYM% decreased from 35.52 ± 10.44 preoperatively to 14.36 ± 7.27 postoperatively. NEU% increased from 54.72 ± 11.85 preoperatively to 77.72 ± 7.16 postoperatively. The WBC count increased from 5.97± 1.65 preoperatively to 8.34 ± 2.71 postoperatively. The LNR decreased from 0.72 ± 0.31 preoperatively to 0.18 ± 0.11 postoperatively. Neurological dysfunction was somewhat recovered in the postoperative period (6 months to 2 years) in all patients.
Conclusion: In summary, this clinical study successfully established a predictive model with significant prognostic value for postoperative neurological dysfunction in patients with spinal tuberculosis. Notably, based on the ranking of variable contributions, the use of antituberculosis drugs may play a pivotal role in the development of postoperative neurological dysfunction in spinal tuberculosis patients. A well-validated nomogram incorporating acid-fast staining and piezosurgery use may facilitate preoperative risk stratification. Prolonged exposure of the spinal cord to a highly inflammatory environment may serve as a risk factor for intraoperative spinal cord injury in these patients. Furthermore, identical or similar surgical procedures may yield differential clinical outcomes across different disease subtypes and individual patients.

Keywords: spinal tuberculosis, neurological dysfunction, immune microenvironment, inflammatory response