Skip to main content Skip to main navigation menu Skip to site footer

Surgical outcomes among spinal tuberculosis patients: a study from a provincial reference hospital in Indonesia

  • Azharuddin ,
  • Adinda Zahra Ayufi Ramadhani ,
  • Nirwana Lazuardi Sary ,
  • Safrizal Rahman ,
  • Mulkan Azhary ,


Abstract

Link of Video Abstract: https://youtu.be/_5_xwPSsNFc

 

Introduction: Spinal tuberculosis is one of the most common forms of extrapulmonary tuberculosis, which can cause a significant loss of functional ability and decrease in quality of life. Surgery has become an integral component in the current management of spinal tuberculosis that could improve neurological deficits and functional status, yet it may expose patients to surgical site infection (SSI). The aim of the study was to observe the incidence of SSI and improved neurological deficits and functional status post-surgery among patients with spinal tuberculosis.

Methods: The medical records (n=91) were collected retrospectively from patients admitted between January 2019 and June 2022. Characteristic data collected in this study included age, gender, education, occupation, domicile, history of smoking, history of pulmonary tuberculosis, presence of comorbidity. Patients were contacted for history of SSI, postoperative neurological deficits, and functional status assessments through interview using Frankel Grade and Barthel Index instruments, respectively.

Results: The results revealed that only two percent of the total patients developed SSI. Number of patients with Frankel Grade E increased from 0 to 72 (79.1%), and only three patients (3.3%) had persistent Frankel Grade B after the surgery. Sixty-eight patients (74.7%) who underwent the surgery enjoyed independent state of functional status, whereas prior to the surgery, the number was smaller (n=18, 19.8%). The favorable surgical outcomes were found predominantly in female patients (83.9%), 17–25-year-old patients (93.3%), and those having no history of smoking (82.5%–84.2%) and comorbid disease (81.9%–83.3%). The recovery was mostly observed 1–2 years post-surgery (87.2%).

Conclusion: Spinal surgery for patients with spinal tuberculosis improves neurological deficits and functional status. The risk of contracting SSI after the surgery is considered to be low.

Keywords: Spinal tuberculosis neurological deficit functional status surgical site infection spinal surgery

References

  1. Chakaya J, Petersen E, Nantanda R, Mungai BN, Migliori GB, Amanullah F, et al. The WHO Global Tuberculosis 2021 Report - not so good news and turning the tide back to End TB. Int J Infect Dis. 2022/03/20. 2022;124 Suppl 1:S26–9. Available from: https://pubmed.ncbi.nlm.nih.gov/35321845
  2. Winardi W, Wahyuni H, Hidayat M, Wirawan A, Nurwidya F, Uddin MN, et al. Challenges on tuberculosis care in health care facilities during COVID-19 pandemic: Indonesian perspective. Narra J 2022; 2(2):e80-86. Available from: DOI: https://doi.org/10.52225/narra.v2i2.80
  3. Machlaurin A. Health economic evaluations of tuberculosis control in Indonesia [Internet]. University of Groningen Press; Available from: http://dx.doi.org/10.33612/diss.257346205
  4. Bagcchi S. Dismal global tuberculosis situation due to COVID-19. Lancet Infect Dis. 2021;21(12):1636. Available from: https://pubmed.ncbi.nlm.nih.gov/34838229
  5. Falah M, Tai C-Y, Lu Y-Y, Liu C-Y, Lismayanti L. Tuberculosis Knowledge among University Students in Indonesia. South East Asia Nurs Res. 2019;1(2):95. Available from: http://dx.doi.org/10.26714/seanr.1.2.2019.95-105
  6. Widyastuti NN, Nugraheni WP, Miko Wahyono TY, Yovsyah Y. The Relationship between Nutritional Status and the Incidence of Pulmonary Tuberculosis in Children Aged 1-5 Years in Indonesia. Bul Health Sist Researcher. 2021;24(2):89–96. Available from: http://dx.doi.org/10.22435/hsr.v24i2.3793
  7. Terekeci H, Kucukardali Y, Top C, Onem Y, Celik S, Öktenli Ç. Risk assessment study of the pressure ulcers in intensive care unit patients. Eur J Intern Med. 2009;20(4):394–7. Available from: http://dx.doi.org/10.1016/j.ejim.2008.11.001
  8. Yong LN, Ahmedy F, Yin KN, Engkasan JP. Functional Outcomes in Spinal Tuberculosis: A Review of the Literature. Asian Spine J. 2020/09/22. 2021;15(3):381–91. Available from: https://pubmed.ncbi.nlm.nih.gov/32951405
  9. Moon M-S, Woo Y-K, Lee K-S, Ha K-Y, Kim S-S, Sun D-H. Posterior Instrumentation and Anterior Interbody Fusion for Tuberculous Kyphosis of Dorsal and Lumbar Spines. Spine (Phila Pa 1976). 1995;20(17):1910–6. Available from: http://dx.doi.org/10.1097/00007632-199509000-00013
  10. Kotil K, Alan MS, Bilge T. Medical management of Pott disease in the thoracic and lumbar spine: a prospective clinical study. J Neurosurg Spine. 2007;6(3):222–8. Available from: http://dx.doi.org/10.3171/spi.2007.6.3.222
  11. Yao R, Zhou H, Choma TJ, Kwon BK, Street J. Surgical Site Infection in Spine Surgery: Who Is at Risk? Glob spine J. 2018/12/13. 2018;8(4 Suppl):5S-30S. Available from: https://pubmed.ncbi.nlm.nih.gov/30574441
  12. Farfán Cano GG, Farfán Cano SG, Farfán Cano HR, Silva Rojas GA, Silva Rojas KJ. Revisión Acerca de Comamonas Kerstersii como Agente Infeccioso. Investigatio. 2021;(16):1–7. Available from: http://dx.doi.org/10.31095/investigatio.2020.16.1
  13. Collin C, Wade DT, Davies S, Horne V. The Barthel ADL Index: A reliability study. Int Disabil Stud. 1988;10(2):61–3. Available from: http://dx.doi.org/10.3109/09638288809164103
  14. Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH, et al. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Spinal Cord. 1969;7(3):179–92. Available from: http://dx.doi.org/10.1038/sc.1969.30
  15. Ali A, Musbahi O, White VLC, Montgomery AS. Spinal Tuberculosis. JBJS Rev. 2019;7(1):e9–e9. Available from: http://dx.doi.org/10.2106/jbjs.rvw.18.00035
  16. Ruparel S, Tanaka M, Mehta R, Yamauchi T, Oda Y, Sonawane S, et al. Surgical Management of Spinal Tuberculosis-The Past, Present, and Future. Diagnostics (Basel, Switzerland). 2022;12(6):1307. Available from: https://pubmed.ncbi.nlm.nih.gov/35741117
  17. Azharuddin A, Harapan H, Fajar JK. Surgical Site Infection Following Open Posterior Spine Surgery: Which is the Most Affected?. Bakirkoy Tip Derg / Med J Bakirkoy. 2018;14(4):389–93. Available from: http://dx.doi.org/10.4274/btdmjb.20171114065534
  18. Quraishi NA, Rajabian A, Spencer A, Arealis G, Mehdian H, Boszczyk BM, et al. Reoperation rates in the surgical treatment of spinal metastases. Spine J. 2015;15(3):S37–43. Available from: http://dx.doi.org/10.1016/j.spinee.2015.01.005
  19. Quraishi NA, Ahmed MS, Arealis G, Boszczyk BM, Edwards KL. Does surgical site infection influence neurological outcome and survival in patients undergoing surgery for metastatic spinal cord compression? Eur Spine J. 2018;28(4):792–7. Available from: http://dx.doi.org/10.1007/s00586-018-5797-4
  20. Sugita S, Hozumi T, Yamakawa K, Goto T, Kondo T. Risk factors for surgical site infection after posterior fixation surgery and intraoperative radiotherapy for spinal metastases. Eur Spine J. 2015;25(4):1034–8. Available from: http://dx.doi.org/10.1007/s00586-015-4116-6
  21. Manoso MW, Cizik AM, Bransford RJ, Bellabarba C, Chapman J, Lee MJ. Medicaid status is associated with higher surgical site infection rates after spine surgery. Spine (Phila Pa 1976). 2014;39(20):1707–13. Available from: https://pubmed.ncbi.nlm.nih.gov/24983931
  22. Chaichana KL, Bydon M, Santiago-Dieppa DR, Hwang L, McLoughlin G, Sciubba DM, et al. Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases. J Neurosurg Spine. 2014;20(1):45–52. Available from: http://dx.doi.org/10.3171/2013.10.spine1364
  23. Martin CT, Gao Y, Duchman KR, Pugely AJ. The Impact of Current Smoking and Smoking Cessation on Short-Term Morbidity Risk After Lumbar Spine Surgery. Spine (Phila Pa 1976). 2016;41(7):577–84. Available from: http://dx.doi.org/10.1097/brs.0000000000001281
  24. Hikata T, Iwanami A, Hosogane N, Watanabe K, Ishii K, Nakamura M, et al. High preoperative hemoglobin A1c is a risk factor for surgical site infection after posterior thoracic and lumbar spinal instrumentation surgery. J Orthop Sci. 2014;19(2):223–8. Available from: http://dx.doi.org/10.1007/s00776-013-0518-7
  25. Boszczyk BM, Boszczyk AA, Putz R. Comparative and functional anatomy of the mammalian lumbar spine. Anat Rec. 2001;264(2):157–68. Available from: http://dx.doi.org/10.1002/ar.1156
  26. Toulgui E, Jemni S, Frioui S, Lazreg N, Mtaouaa S, Khachnaoui F. Management in a rehabilitation department in Pott’s disease. Ann Phys Rehabil Med. 2016;59:e96. Available from: http://dx.doi.org/10.1016/j.rehab.2016.07.218
  27. Yen HL, Kong KH, Chan W. Infectious disease of the spine: outcome of rehabilitation. Spinal Cord. 1998;36(7):507–13. Available from: http://dx.doi.org/10.1038/sj.sc.3100609
  28. Kakutani K, Sakai Y, Maeno K, Takada T, Yurube T, Kurakawa T, et al. Prospective Cohort Study of Performance Status and Activities of Daily Living After Surgery for Spinal Metastasis. Clin Spine Surg A Spine Publ. 2017;30(8):E1026–32. Available from: http://dx.doi.org/10.1097/bsd.0000000000000456
  29. Chen W-J, Chen C-H, Shih C-H. Surgical treatment of tuberculous spondylitis: 50 patients followed for 2-8 years. Acta Orthop Scand. 1995;66(2):137–42. Available from: http://dx.doi.org/10.3109/17453679508995507
  30. Kiran NAS, Vaishya S, Kale SS, Sharma BS, Mahapatra AK. Surgical results in patients with tuberculosis of the spine and severe lower-extremity motor deficits: a retrospective study of 48 patients. J Neurosurg Spine. 2007;6(4):320–6. Available from: http://dx.doi.org/10.3171/spi.2007.6.4.6
  31. Anand PA, Keshavamurthy S, Shelley EM, Saha S. Does Age Affect the Short- and Long-Term Outcomes of Coronary Bypass Grafting? Int J Angiol. 2021;30(3):202–11. Available from: https://pubmed.ncbi.nlm.nih.gov/34776820
  32. Park DW, Sohn JW, Kim E-H, Cho D-I, Lee J-H, Kim K-T, et al. Outcome and Management of Spinal Tuberculosis According to the Severity of Disease. Spine (Phila Pa 1976). 2007;32(4):E130–5. Available from: http://dx.doi.org/10.1097/01.brs.0000255216.54085.21
  33. 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. Available from: http://dx.doi.org/10.15851/jap.v8n1.1964
  34. Akzatama N, Rahmawati LD. A tuberculosis spondylitis patient with paraplegic manifestations. Bali Med J. 2023;12(1):888-92. Available from: https://www.balimedicaljournal.org/index.php/bmj/article/view/4062

How to Cite

Azharuddin, Ramadhani, A. Z. A. ., Sary, N. L. ., Rahman, S. ., & Azhary, M. . (2023). Surgical outcomes among spinal tuberculosis patients: a study from a provincial reference hospital in Indonesia . Bali Medical Journal, 12(3), 2373–2377. https://doi.org/10.15562/bmj.v12i3.4557
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver
Download Citation
Endnote/Zotero/Mendeley (RIS) BibTeX

HTML
1

Total
1

Share

Search Panel

Azharuddin
Google Scholar
Pubmed
BMJ Journal

Adinda Zahra Ayufi Ramadhani
Google Scholar
Pubmed
BMJ Journal

Nirwana Lazuardi Sary
Google Scholar
Pubmed
BMJ Journal

Safrizal Rahman
Google Scholar
Pubmed
BMJ Journal

Mulkan Azhary
Google Scholar
Pubmed
BMJ Journal