DOI: 10.1097/bn9.0000000000000131 ISSN: 3066-8905

Operative Versus Nonoperative Management of Spinal Tuberculosis: A Retrospective Comparative Cohort Study of 162 Patients From Northern Nigeria

Mutaleeb A. Shobode, Rami Rajjoub, Oladapo Ekundayo, Muhammad L. Mamman, John E. Onuminya, Muhammad N. Salihu
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Study Design:

Retrospective comparative cohort study.

Background:

Spinal tuberculosis remains a major cause of spinal deformity and neurological impairment in low-income and middle-income countries. Although antituberculous chemotherapy remains the mainstay of treatment, surgery is often required in patients with neurological deficit, instability, or progressive deformity. Data from sub-Saharan Africa are limited.

Objective:

To describe the clinical profile and compare outcomes of operative versus nonoperative treatment and identify predictors of neurological improvement.

Materials and Methods:

A retrospective cohort study was conducted of patients with tuberculous spondylitis treated between 2014 and 2019 at a specialist center in Northern Nigeria. Patients with ≥1-year follow-up were included. Treatment was either nonoperative (chemotherapy with or without external support) or operative (decompression, debridement, fusion, and stabilization). Outcomes included neurological improvement, spinal stability, kyphosis correction, and hospital stay. Multivariable logistic regression was used to identify independent predictors of neurological recovery.

Results:

Of 162 patients, 124 completed follow-up. Mean age was 36.0±11.2 years, with male predominance (2.4:1). Thoracic involvement was most common (48%). Neurological deficit was present in 93.5% and kyphotic deformity in 31.4%. Most patients were managed nonoperatively (69.4%), while 30.6% underwent surgery. Neurological improvement was significantly higher in the operative group (92.1% vs . 65.1%, P =0.002). Surgical treatment also achieved greater mechanical stability and shorter hospital stay (22.7±2.7 vs . 57.2±19.8 d, P <0.001). On multivariable analysis, operative treatment independently predicted neurological improvement (OR: 22.59, 95% CI: 3.92–130.33; P =0.0005). Longer symptom duration, increased kyphosis angle, and thoracolumbar involvement were associated with poorer outcomes.

Conclusions:

While chemotherapy remains fundamental, surgical intervention improves neurological recovery and spinal stability in appropriately selected patients. Outcomes are strongly influenced by disease chronicity and deformity, emphasizing the importance of early diagnosis and timely intervention.

Level of Evidence:

Level III.

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