Surgical Management of Spinal Tuberculosis

Spinal tuberculosis remains a critical form of extrapulmonary tuberculosis, posing risks of neurological deficit, deformity and chronic pain. Surgical intervention complements antitubercular chemotherapy by achieving debridement of necrotic tissue, decompression of neural elements, reconstruction of the spinal column and restoration of alignment. Approaches may be anterior, posterior or combined, each selected on the basis of disease location, spinal stability and the patient’s overall health. An anterior approach allows direct access to the diseased vertebrae for radical debridement and bone graft insertion, while posterior methods facilitate fixation and deformity correction. Advances in instrumentation – including titanium meshes, polyamide cages or autologous bone grafts – enable stable reconstruction even in extensive defects. The lateral extracavitary route offers an alternative corridor to thoracic lesions, combining thorough lesion clearance with rigid fixation. A growing emphasis on minimally invasive techniques seeks to reduce operative morbidity and expedite recovery. Concurrently, predictive models based on clinical indicators are emerging to guide surgical decision-making and anticipate complications such as spinal cord injury. Ongoing research aims to refine surgical algorithms, optimise hardware selection and tailor interventions to regional disease patterns, thereby mitigating long-term disability and improving quality of life worldwide.

Research from Nature Portfolio

Recent clinical modelling efforts have harnessed machine learning to predict spinal cord injury in patients undergoing surgery for spinal tuberculosis. By evaluating ten key clinical parameters, a random forest algorithm demonstrated robust performance in identifying patients at highest risk of neurological impairment. The model achieved high discrimination and calibration across both internal and external hospital cohorts, enabling personalised risk assessment. Deployment of this tool via an interactive web interface facilitates rapid preoperative stratification, informing surgical planning and intensity of monitoring. Such predictive frameworks offer a data-driven adjunct to conventional surgical judgement, with the potential to reduce postoperative morbidity through targeted interventions.

Surgical Management of Spinal Tuberculosis publication trend

The graph below shows the total number of articles in surgical management of spinal tuberculosis across all publications each year (not limited to Nature Index journals).

Technical terms

Debridement: Surgical removal of necrotic and infected tissue to reduce microbial load and prevent disease progression.

Instrumentation: Use of surgical implants such as rods, screws or cages to stabilise the spine after debridement.

Anterior approach: Surgical access through the front of the spine, allowing direct lesion clearance and graft placement.

Posterior approach: Access via the back of the spine, often employed for fixation and correction of deformity.

Lateral extracavitary approach: Posterolateral corridor to the thoracic spine combining aspects of anterior and posterior access.

Bone graft fusion: Biological or synthetic material used to bridge vertebral defects, promoting osteointegration and spinal stability.

Kyphosis: Abnormal forward curvature of the spine, commonly addressed during deformity correction.

References

1. A comparison of anterior reconstruction of spinal defect using nano-hydroxyapatite/polyamide 66 cage and autologous iliac bone for thoracolumbar tuberculosis: a stepwise propensity score matching analysis. Frontiers in Bioengineering and Biotechnology (2024).
2. Anterior debridement combined with autogenous iliac bone graft fusion for the treatment of lower cervical tuberculosis: a multicenter retrospective study. Journal of Orthopaedics and Traumatology (2023).
3. Prediction model for spinal cord injury in spinal tuberculosis patients using multiple machine learning algorithms: a multicentric study. Scientific Reports (2024).
4. Debridement and bone graft fusion via the lateral extracavitary approach combined with lateral and posterior screw-rod fixation in the treatment of thoracic spinal tuberculosis: A retrospective study of 38 cases. Heliyon (2024).