Diagnostic and therapeutic outcomes in spinal tuberculosis: a retrospective study integrating GeneXpert MTB/RIF, histopathology, and clinical management strategies.

Purpose: Spinal tuberculosis (STB) remains prevalent in developing nations and significantly contributes to morbidity, often resulting in kyphotic deformity and neurological deficits. In this study, we correlate the diagnostic, therapeutic and prognostic factors according to the current standard of management of STB.

Methods: This retrospective study evaluated diagnostic and prognostic factors in 77 patients with STB treated surgically (37.7%) or non-surgically (62.3%) between 2018 and 2023. Diagnostic tools included GeneXpert MTB/RIF(GXMTB/RIF)- a rapid molecular test for detecting Mycobacterium tuberculosis and rifampicin resistance- and histopathological confirmation via biopsy. Clinical outcomes were assessed using Visual Analogue Scale, Oswestry Disability Index, inflammatory markers (ESR, CRP), kyphotic deformity correction, and neurological improvement.

Results: GeneXpert MTB/RIF detected Mycobacterium tuberculosis in 94.8% of cases, with 5.2% showing rifampicin resistance. Histopathology revealed granulomatous infiltration in 96.1% of biopsies, underscoring the importance of combining diagnostic methods. Both groups showed significant improvement over 12 months, with surgical patients exhibiting higher baseline kyphosis angles (47.41° vs. 19.27°, p < 0.001) and greater post-treatment correction (14.14° vs. 2.71°, p = 0.04). Neurological status, evaluated via ASIA Impairment Scale improved post-treatment, with 93.5% achieving normal neurology. Deformity presence strongly correlated with surgical intervention (51.9% vs. 8%, p < 0.001).

Conclusion: The study highlights the efficacy of anti-tubercular therapy (ATT) and the role of surgery in severe deformity or neurological compromise. Notably, rare discrepancies between GXMTB/RIF and histopathology (5.2% GXMTB/RIF - negative but histopathology- positive) emphasize the need for clinical judgment alongside laboratory findings. Surgical intervention is pivotal for deformity correction and neurological recovery, while ATT remains the cornerstone.