Objective: Early diagnosis of spinal tuberculosis remains challenging, and inappropriate percutaneous vertebral augmentation can aggravate lesions and worsen clinical symptoms. Relevant clinical evidence on subsequent standardized management remains limited. This study aimed to investigate the clinical efficacy and prognostic outcomes of different treatment strategies in patients with spinal tuberculosis following inappropriate percutaneous vertebral augmentation, and to analyze the clinical characteristics of the patients and provide clinical data for the differential diagnosis of spinal tuberculosis.
Methods: The clinical data of 53 patients with spinal tuberculosis who underwent vertebral augmentation between January 2012 and January 2024 were retrospectively analyzed. There were 26 males and 27 females, with a mean age of 70.33 ± 5.88 years (range 53–86 years). Thirty-one patients had thoracic tuberculosis, and 22 had lumbar tuberculosis. According to the ASIA Impairment Scale, 7 patients were grade B, 15 were grade C, 24 were grade D, and 7 were grade E. At admission, 52 patients had elevated erythrocyte sedimentation rates (ESRs) and C-reactive protein (CRP) levels, 36 had positive T-SPOT results, and 1 patient had a normal ESR and CRP level and negative T-SPOT result. Twenty-seven patients had single-vertebral involvement, and 26 had multiple-vertebral involvement. Patients were divided into two groups, and a retrospective cohort comparative analysis was conducted: Surgical group (35 patients) received posterior spinal canal decompression, bone graft fusion, and internal fixation; conservative group (18 patients) received non-surgical treatment. Outcomes included ESR, CRP level, VAS score, ASIA grade, and MBI score. Enumeration data were analyzed with the χ2 test for intergroup differences in proportions. Normally distributed continuous data were compared using the independent samples t-test. Non-normally distributed continuous data were analyzed using the Mann–Whitney U test. Paired comparisons were performed using the Wilcoxon signed-rank test. Repeated measures data were analyzed using the rank-sum test.
Results: The follow-up period ranged from 18 to 36 months. Early postoperative increases in the ESR and CRP level were significantly greater in the surgical group than in the conservative group, but inflammatory marker levels normalized within 3–6 months in both groups. Before treatment, there were no significant differences in the ESR, CRP level, VAS score, MBI, or ASIA grade between the groups (all p > 0.05). At 3 months and at the final follow-up, the ESR, CRP level, and VAS score decreased significantly and the MBI and ASIA grades improved significantly in both groups (all p < 0.05). The MBI was significantly better in the surgical group at 3 months (p < 0.05). At the final follow-up, no significant differences were found between the groups in any index (all p > 0.05).
Conclusion: This retrospective cohort study shows that compared with conservative treatment, surgical treatment results in faster symptomatic and functional recovery in patients with neurological compression after mismanaged vertebral augmentation for spinal tuberculosis. For patients without significant neurological compression or those who are unfit for surgery, conservative treatment achieves satisfactory long-term efficacy, although the recovery time is longer. Long-term outcomes are comparable between the two strategies.
| [1] |
R. N. Dunn and M. Ben Husien, “Spinal Tuberculosis: Review of Current Management,” Bone & Joint Journal 100, no. 4 (2018): 425–431.
|
| [2] |
D. Goletti, G. Meintjes, B. B. Andrade, A. Zumla, and S. S. Lee, “Insights From the 2024 WHO Global Tuberculosis Report - More Comprehensive Action, Innovation, and Investments Required for Achieving WHO End TB Goals,” International Journal of Infectious Diseases 150 (2025): 107325.
|
| [3] |
S. Y. Rodriguez-Takeuchi, M. E. Renjifo, and F. J. Medina, “Extrapulmonary Tuberculosis: Pathophysiology and Imaging Findings,” Radiographics 39, no. 7 (2019): 2023–2037.
|
| [4] |
S. M. Tuli, “Tuberculosis of the Spine: A Historical Review,” Clinical Orthopaedics and Related Research 460 (2007): 29–38.
|
| [5] |
H. Abdelrahman, A. E. Siam, A. Shawky, A. Ezzati, and H. Boehm, “Infection After Vertebroplasty or Kyphoplasty. A Series of Nine Cases and Review of Literature,” Spine Journal 13, no. 12 (2013): 1809–1817.
|
| [6] |
J. Gan, C. Zhang, D. Tang, and X. Du, “Surgical Treatment of Spinal Tuberculosis: An Updated Review,” European Journal of Medical Research 29, no. 1 (2024): 588.
|
| [7] |
J. W. Park, S. M. Park, H. J. Lee, C. K. Lee, B. S. Chang, and H. Kim, “Infection Following Percutaneous Vertebral Augmentation With Polymethylmethacrylate,” Archives of Osteoporosis 13, no. 1 (2018): 47.
|
| [8] |
R. Shanmuganathan, K. Ramachandran, A. P. Shetty, and R. M. Kanna, “Active Tuberculosis of Spine: Current Updates,” North American Spine Society Journal 16 (2023): 100267.
|
| [9] |
K. Khanna and S. Sabharwal, “Spinal Tuberculosis: A Comprehensive Review for the Modern Spine Surgeon,” Spine Journal 19, no. 11 (2019): 1858–1870.
|
| [10] |
W. Liu, J. Wang, Y. Lei, et al., “Deep Learning for Discrimination of Early Spinal Tuberculosis From Acute Osteoporotic Vertebral Fracture on CT,” Infection and Drug Resistance 18 (2025): 31–42.
|
| [11] |
Committee AAIS, “The 2019 Revision of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)-What's New?,” Spinal Cord 57, no. 10 (2019): 815–817.
|
| [12] |
S. Kirshblum, B. Snider, R. Rupp, and M. S. Read, “Updates of the International Standards for Neurologic Classification of Spinal Cord Injury: 2015 and 2019,” Physical Medicine and Rehabilitation Clinics of North America 31, no. 3 (2020): 319–330.
|
| [13] |
T. T. Roberts, G. R. Leonard, and D. J. Cepela, “Classifications in Brief: American Spinal Injury Association (ASIA) Impairment Scale,” Clinical Orthopaedics and Related Research 475, no. 5 (2017): 1499–1504.
|
| [14] |
D. Garg and V. Goyal, “Spinal Tuberculosis Treatment: An Enduring Bone of Contention,” Annals of Indian Academy of Neurology 23, no. 4 (2020): 441–448.
|
| [15] |
S. Ferfeli, A. Galanos, I. A. Dontas, A. Triantafyllou, I. K. Triantafyllopoulos, and E. Chronopoulos, “Reliability and Validity of the Greek Adaptation of the Modified Barthel Index in Neurorehabilitation Patients,” European Journal of Physical and Rehabilitation Medicine 60, no. 1 (2024): 44–54.
|
| [16] |
A. P. Rathod, Y. B. Rathod, R. Baitule, G. Pundkar, H. S. Saodekar, and A. Suhagpure, “To Study the Functional Outcome of Vertebroplasty Versus Conservative Management in Osteoporotic Fractures,” Journal of Orthopaedic Case Reports 15, no. 5 (2025): 274–278.
|
| [17] |
S. Ramanathan, Y. C. Lin, S. Thirumurugan, C. C. Hu, Y. F. Duann, and R. J. Chung, “Poly(Methyl Methacrylate) in Orthopedics: Strategies, Challenges, and Prospects in Bone Tissue Engineering,” Polymers 16, no. 3 (2024): 367.
|
| [18] |
Y. Yang, F. Liao, X. Xing, et al., “The Reduced Cortical Bone Density in Vertebral Bodies: Risk for Osteoporotic Fractures? Insights From CT Analysis,” Journal of Orthopaedic Surgery and Research 19, no. 1 (2024): 486.
|
| [19] |
G. Javed, A. A. Laghari, S. I. Ahmed, et al., “Development of Criteria Highly Suggestive of Spinal Tuberculosis,” World Neurosurgery 116 (2018): e1002–e1006.
|
| [20] |
C. Y. Ge, L. M. He, Y. H. Zheng, et al., “Tuberculous Spondylitis Following Kyphoplasty,” Medicine (Baltimore) 95, no. 11 (2016): e2940.
|
| [21] |
B. Wang, W. Gao, and D. Hao, “Current Study of the Detection and Treatment Targets of Spinal Tuberculosis,” Current Drug Targets 21, no. 4 (2020): 320–327.
|
| [22] |
H. Zeng, Y. Liang, J. He, et al., “Analysis of Clinical Characteristics of 556 Spinal Tuberculosis Patients in Two Tertiary Teaching Hospitals in Guangxi Province,” BioMed Research International 2021 (2021): 1344496.
|
| [23] |
C. H. Chen, Y. M. Chen, C. W. Lee, Y. J. Chang, C. Y. Cheng, and J. K. Hung, “Early Diagnosis of Spinal Tuberculosis,” Journal of the Formosan Medical Association 115, no. 10 (2016): 825–836.
|
| [24] |
Y. Aljehani, L. Althunayyan, R. Alghamdi, S. Aljamaan, M. Alwazzeh, and F. Alreshaid, “Exploring Thoracolumbar Pott's Disease in the Immunocompetent; Institutional Experience Over a Decade and Comprehensive Literature Review,” Medical Archives 79, no. 1 (2025): 41–46.
|
| [25] |
A. K. Jain, “Tuberculosis of the Spine: A Fresh Look at an Old Disease,” Journal of Bone and Joint Surgery. British Volume 92, no. 7 (2010): 905–913.
|
| [26] |
C. Y. Ge, L. M. He, Y. H. Zheng, et al., “Tuberculous Spondylitis Following Kyphoplasty: A Case Report and Review of the Literature,” Medicine (Baltimore) 95, no. 11 (2016): e2940.
|
| [27] |
W. Pi, Y. Liu, H. Chen, and H. Zhao, “Tuberculous Spondylitis and Paravertebral Abscess Formation Following Vertebroplasty: A Case Report and Review of the Literature,” Infection and Drug Resistance 17 (2024): 5171–5178.
|
| [28] |
S. Jia-Jia, S. Zhi-Yong, Q. Zhong-Lai, Y. Hui-Lin, and Z. Xiao-Yu, “Tuberculous Spondylitis After Vertebral Augmentation: A Case Report With a Literature Review,” Journal of International Medical Research 46, no. 2 (2018): 916–924.
|
| [29] |
P. Yang, Q. Zang, J. Kang, H. Li, and X. He, “Comparison of Clinical Efficacy and Safety Among Three Surgical Approaches for the Treatment of Spinal Tuberculosis: A Meta-Analysis,” European Spine Journal 25, no. 12 (2016): 3862–3874.
|
| [30] |
S. Bouvresse, J. Chiras, F. Bricaire, and P. Bossi, “Pott's Disease Occurring After Percutaneous Vertebroplasty: An Unusual Illustration of the Principle of Locus Minoris Resistentiae,” Journal of Infection 53, no. 6 (2006): e251–e253.
|
| [31] |
X. Hu, G. Zhang, H. Zhang, et al., “A Predictive Model for Early Clinical Diagnosis of Spinal Tuberculosis Based on Conventional Laboratory Indices: A Multicenter Real-World Study,” Frontiers in Cellular and Infection Microbiology 13 (2023): 1150632.
|
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