{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T04:25:39Z","timestamp":1793679939614,"version":"4.5.1"},"reference-count":33,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Ganga Orthopaedic Research and Education Foundation","id":[{"id":"https:\/\/ror.org\/029xgej46","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Retrospective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the association between mechanical instability and neurological deficit in spinal tuberculosis (TB), and compare it against previously recognized radiological parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Clinical and radiological data of patients with active thoracic spinal TB were evaluated. Instability was assessed using the Spinal Tuberculosis Instability Scoring System (STISS) by Rajasekaran et al. Neurological status and radiological parameters were analysed to identify the factors associated with neurological deficit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 122 patients were included. The average age was 51 \u00b1 18\u00a0years, and 54.9% were males. 40 (32.8%) patients had neurological deficits at presentation. Based on the STISS, 71 (58%) patients were categorised as stable, 10 (8.2%) as potentially unstable, and 41 (34%) as definitely unstable. On MRI, cord signal changes and epidural compression were noted in 18% and 64% of the patients, respectively. Definite instability was found to be the strongest independent association of neurological deficit (OR 9.77, 95% CI 2.85-38.9,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), followed by greater canal encroachment area (CEA) (OR 1.08, 95% CI 1.03-1.13,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.002). In a stable spine with epidural compression, the predicted probability of neurological deficit is 27%. In an unstable spine, the likelihood of neurological deficit is 50% even without epidural compression, and highest (63%) when instability was associated with epidural compression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Mechanical instability is the strongest independent association of neurological deficit in spinal TB, even in the absence of epidural compression. Incorporating the Spine Instability Scoring System into routine clinical evaluation improves risk stratification, enables timely decision-making, and can prevent irreversible neurological deficits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682261451174","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T19:49:52Z","timestamp":1778269792000},"page":"4012-4023","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Beyond Cord Compression: Instability as a Major Driver for Neurological Deficit in Active Thoracic Spinal Tuberculosis"],"prefix":"10.1177","volume":"16","author":[{"given":"Harikrishna","family":"Raghuraj Ramasamy","sequence":"first","affiliation":[{"name":"Ganga Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7167-2228","authenticated-orcid":false,"given":"Gnanaprakash","family":"Gurusamy","sequence":"additional","affiliation":[{"name":"Ganga Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8885-5411","authenticated-orcid":false,"given":"Sri Vijay Anand","family":"K S","sequence":"additional","affiliation":[{"name":"Ganga Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5885-7152","authenticated-orcid":false,"given":"Ajoy Prasad","family":"Shetty","sequence":"additional","affiliation":[{"name":"Ganga Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5817-4909","authenticated-orcid":false,"given":"Rishi Mugesh","family":"Kanna","sequence":"additional","affiliation":[{"name":"Ganga Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mogan","family":"Kaviprawin","sequence":"additional","affiliation":[{"name":"Ganga Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6043-006X","authenticated-orcid":false,"given":"Shanmuganathan","family":"Rajasekaran","sequence":"additional","affiliation":[{"name":"Ganga Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"e_1_3_4_2_2","volume-title":"Global Tuberculosis Report","year":"2024","unstructured":"Global Tuberculosis Report; 2024. Accessed October 31, 2025.https:\/\/www.who.int\/teams\/global-programme-on-tuberculosis-and-lung-health\/tb-reports\/global-tuberculosis-report-2024"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","unstructured":"Leonard MK Blumberg HM. Musculoskeletal Tuberculosis. Microbiol Spectr. 2017;5(2). doi:10.1128\/microbiolspec.TNMI7-0046-2017. 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