Comprehensive Spinal Tuberculosis Score: A Clinical Guide for the Management of Thoracolumbar Spinal Tuberculosis

Area of Science:

• Orthopedics
• Infectious Diseases
• Neurosurgery

Background:

• Clinical management of adult thoracolumbar spinal tuberculosis (TB) lacks standardized decision-making guidelines for operative versus conservative treatment.
• Surgeons rely on experience due to differing consensus on clinico-radiological parameters for spinal TB.
• No existing scoring system holistically integrates multiple facets of spinal TB for clinical decision support.

Purpose of the Study:

• To formulate a simple, comprehensive scoring tool for guiding clinical management decisions in adult thoracolumbar spinal TB.
• To establish a standardized approach for treatment selection in spinal TB cases.

Main Methods:

• Utilized the RAND/UCLA appropriateness method with 10 spine surgery experts from tertiary care centers.
• Identified vital characteristics influencing spinal TB treatment decisions and developed a scoring tool based on component severity.
• Determined cutoff scores using ROC curves from 151 patients with 1-year follow-up data.

Main Results:

• Developed the Comprehensive Spinal TB Score (CSTS) incorporating pain, kyphosis angle, vertebral destruction, and neurological status.
• Established score classifications: <5.5 (conservative), 5.5-6.5 (conservative/operative), and >6.5 (operative) management.
• The CSTS reflects mechanical stability, neurological stability, and disease stabilization.

Conclusions:

• The CSTS provides a practical tool for decision-making in adult thoracolumbar spinal TB management.
• Aims to serve as a common language for spine surgeons discussing thoracolumbar spinal TB cases.
• Further multicenter studies are required to validate the CSTS's reliability and reproducibility.