Autonomic dysfunction and adrenal insufficiency in thoracic spine tuberculosis

Area of Science:

• Anesthesiology
• Neurosurgery
• Endocrinology

Background:

• Autonomic dysfunction is known in spinal tuberculosis (TB) patients, but its surgical consequences are unclear.
• Spinal TB can affect neurological and physiological functions, potentially impacting surgical outcomes.

Purpose of the Study:

• To investigate the consequences of autonomic dysfunction in paraplegic patients with thoracic spine tuberculosis undergoing surgery.
• To compare autonomic function and surgical complications between spinal TB patients and a control group.

Main Methods:

• Matched cohort study comparing 25 spinal TB patients (Group S) with 25 controls (Group C).
• Autonomic function tests (heart rate, respiratory ratio, heart rate variability) were performed intraoperatively.
• Preoperative adrenocorticotropic hormone stimulation test was conducted for Group S patients.

Main Results:

• Group S showed higher resting heart rate, lower expiratory:inspiratory ratio, and higher heart rate variability, suggesting parasympathetic dysfunction and sympathetic overactivity.
• 100% of Group S patients experienced hypotension compared to 44% in Group C.
• Eight of 17 Group S patients had adrenal insufficiency; significant blood pressure drops occurred without compensatory tachycardia.

Conclusions:

• Spinal TB patients exhibit significant autonomic dysfunction, increasing surgical risks like hypotension and potentially adrenal insufficiency.
• Coexisting pulmonary TB is a critical factor influencing surgical strategy and postoperative respiratory complications.