title: Clinical characteristics and neurologic recovery of patients with cervical spinal tuberculosis: should conservative treatment be preferred? A retrospective follow-up study of 115 cases.
abstract: OBJECTIVE
  To present the clinical characteristics and prognostic factors of neurologic recovery in patients with cervical spinal tuberculosis (CST).
  
  
  METHODS
  General description and multivariate analysis were used to detect possible predictors of the outcome of patients with neurologic deficit. Follow-up data were used to generate a Kaplan-Meier curve of neurologic recovery.
  
  
  RESULTS
  Protective factors in neurologic recovery included less involved vertebrae, surgery, and higher Japanese Orthopaedic Association score before treatment; not shorter symptom duration was not a protective factor. Normal neurologic function was present in 30% of patients 6 months after treatment, in 56% of patients 12 months after treatment, and in 93% of patients 28 months after treatment. The cumulative complete neurologic recovery rates at 6 months, 12 months, and 28 months were 44%, 68%, and 91.7% in the surgery group and 16.7%, 38.8%, and 94.4% in the nonsurgery group.
  
  
  CONCLUSIONS
  Surgery and Japanese Orthopaedic Association score before treatment are important predictors of neurologic recovery in patients with CST. A neurologic recovery curve could predict neurologic recovery in patients with CST and indicate in patients with neurologic deficit how long it will take to achieve complete neurologic recovery. The effect of surgery is quick, and the effect of conservative treatment is slower, but no difference in neurologic recovery was found in the long-term. Conservative treatment should be tried in every patient with CST with no obvious indication for surgery. In contrast to patients with tuberculosis without cervical spine involvement but with more complications, comprehensive conservative therapy should be preferred for patients with neurologic deficit to avoid unnecessary surgery and overtreatment and to conserve medical resources. Indications for surgical intervention for CST should be carefully selected.
authors: Department of Orthopedics, No. 44 Hospital, #64 Huanghe RD, 550009, Guiyang, Guizhou, China.
authors: Jin-tao
authors: JT
authors: Qu
authors: Department of Orthopedics, No. 44 Hospital, #64 Huanghe RD, 550009, Guiyang, Guizhou, China.
authors: Yu-quan
authors: YQ
authors: Jiang
authors: Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors: Guo-hua
authors: GH
authors: Xu
authors: Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors: Yu
authors: Y
authors: Tang
authors: Department of Orthopedics, No. 44 Hospital, #64 Huanghe RD, 550009, Guiyang, Guizhou, China.
authors: Zi-tian
authors: ZT
authors: Wang
authors: Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, China. Electronic address: yespine@163.com.
authors: Xiao-jian
authors: XJ
authors: Ye
authors: Department of Orthopedics, No. 44 Hospital, #64 Huanghe RD, 550009, Guiyang, Guizhou, China.
authors: Guo-hua
authors: GH
authors: Shi
authors: Department of Orthopedics, No. 44 Hospital, #64 Huanghe RD, 550009, Guiyang, Guizhou, China.
authors: Ji-wu
authors: JW
authors: Dong
authors: Department of Orthopedics, No. 44 Hospital, #64 Huanghe RD, 550009, Guiyang, Guizhou, China.
authors: Jian
authors: J
authors: Li
authors: Department of Orthopedics, No. 44 Hospital, #64 Huanghe RD, 550009, Guiyang, Guizhou, China.
authors: Jin-lin
authors: JL
authors: Zhou
authors: Department of Orthopedics, No. 44 Hospital, #64 Huanghe RD, 550009, Guiyang, Guizhou, China. Electronic address: 0556814@fudan.edu.cn.
authors: Yue
authors: Y
authors: Hu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D002574:Cervical Vertebrae / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D019635:Neurosurgical Procedures / Q000379:methods; D018579:Patient Selection; D020127:Recovery of Function; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D019564:Unnecessary Procedures; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: Cervical spine; Conservative treatment; Neurologic recovery; Prognostic factors; Tuberculosis