Lost Time, Lost Function: The Impact of Delayed Referral and Surgical Timing on Outcomes in Caries Spine in a Developing Country

Abstract

Objective: In Pakistan, delayed referrals are frequent in spinal TB, leading to late presentations with established neurological deficits and vertebral destruction. We investigated the effects of referral delays and surgical timing on neurological outcomes in surgically treated spinal TB patients.

Materials and Methods: This prospective study was carried out at the Punjab Institute of Neurosciences, Lahore, from January to December 2025. Fifty-six surgical spinal TB patients were grouped as early (less than four weeks from first medical contact to surgery) or delayed (more than four weeks). Neurological status was assessed using Frankel Grade. Hospital stays and complications were also recorded. Chi-square test, independent t-test, and multivariate regression were used for analysis.

Results: Mean age was 38.4 years; 64.3% were male. Delayed presentation occurred in 60.7% of patients, commonly due to misdiagnosis as mechanical backache (57.1%) and financial constraints (50.0%). The thoracolumbar junction was the commonest site (50.0%). The early surgery group showed better neurological improvement (86.4% vs. 67.6%, p=0.024), more complete recoveries (54.5% vs. 29.4%, p=0.048), and shorter hospital stay (12.4 vs. 18.6 days, p=0.001). Delayed referral independently predicted poor outcome (aOR 2.6, p=0.034).

Conclusion: Surgery within four weeks of first medical contact leads to better neurological recovery in spinal TB. Training primary care physicians to recognize spinal TB early and refer promptly can improve patient outcomes.