Does timely surgery or not affect surgical outcomes in patients with severe spinal tuberculous kyphosis? An observational cohort study

Background Spinal tuberculous kyphosis can cause paralysis, severely affecting patient's life. However, timing of the surgery has become a controversial issue. The aim of this study was to explore whether timely surgery would have an impact on surgical outcomes. Methods In this single-center, retrospective, observational cohort study, we collected clinical data of patients with severe spinal tuberculous kyphosis who underwent surgery from July 1st, 2015 to February 28th, 2019 at Shanghai Changzheng Hospital. We obtained patients' consultation, treatment, and follow-up data from the patient database of Shanghai Changzheng Hospital, and divided them into two groups according to whether they received surgery timely. We compared the data of the two groups using neurological function recovery as the primary outcome indicator and complication rates and deformity correction rates as the secondary outcome indicators. Results A total of 43 patients were included. 48.8% patients underwent surgery within 2 years and all patients underwent surgery within 7 years after the neurological symptoms onset. We grouped the patients who were treated surgically after 2 years as non-timely surgery group (Group A, Number of cases: 22) and the patients who were treated within 2 years as timely surgery group (Group B, Number of cases: 21). There was no statistically significant difference in correction rates between the two groups. There was a statistical difference in pulmonary complication rates (P = 0.037) and follow-up neurological function recovery rates (P = 0.021). Conclusion Considering neurological function recovery, deformity correction and complications, we support that patients with severe spinal tuberculous kyphosis should receive surgical treatment as soon as possible after the neurological symptoms onset and preferably within 2 years. This contributes to postoperative neurological recovery in patients as well as reducing the incidence of pulmonary complications.