AO Spine Asia Pacific Regional Conference 2025: Top 9 Abstracts

Abstract Submission ID: 197

Development and internal validation of the Avoid Surgery Predictive Score (ASPS) as a predictive tool to assess surgical risk in spinal metastasis patients undergoing surgery

Warunyu Limmaneevichitr, MD ¹ , Siravich Suvithayasiri, MD ^2,3 , Nath Adulkasem, MD PhD ¹ , Borriwat Santipas, MD ¹ , Korawish Mekariya MD ¹ , Sirichai Wilartratsami, MD ¹ , Pinprapha Boonhyad BA ¹ , Panya Luksanapruksa, MD ¹

¹ Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

² Department of Orthopedics, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand.

³ Bone and Joint Excellence Center, Thonburi Hospital, Bangkok, Thailand.

Introduction: Spinal metastasis surgery is associated with high complications and mortality. The systemic disease status plays a crucial role in determining surgical appropriateness. However, it remains unclear how to accurately identify patients who are unable to tolerate surgery.

Study Design: Retrospective cohort; predictive-tool development.

Objectives: To derive and internally validate the Avoid Surgery Predictive Score (ASPS), a bedside instrument that quantifies perioperative mortality and serious morbidity risk in patients undergoing surgery for spinal metastasis

Methods: Consecutive adults treated surgically at a single tertiary center (2008-2023) were analyzed (n = 467, mean age 58 ± 12 years, 52.7 % male). Demographic, clinical, and laboratory variables were pre-screened; missing values were imputed with predictive mean matching. Dichotomized predictors entered a multivariable logistic regression model with backward elimination. Regression coefficients were converted to integer weights; model discrimination (AuROC).

Results: Five independent predictors—hypoalbuminemia (< 3.5 g/dL, +5), anemia (Hb < 12 g/dL men, < 13 g/dL women, +1), ASIA grade < C (+2), ASA class ≥ 3 (+2), and stage-5 ESRD (+7)—formed a scoring system. Risk strata were defined as safe (0–3), potential intolerance (4–7), and surgery not recommended (≥ 8); the high-risk threshold showed 83 % specificity. In-hospital mortality was 3.4 %, rising fivefold in the ≥ 8 group. The optimism-adjusted AuROC was 0.72 (95 % CI 0.65–0.78).

Conclusions: Considering five main independent variables, ASPS delivers accurate and well-calibrated forecasts of short-term mortality and major complications after spinal metastasis surgery. Its simplicity enables real-time calculation, supports the “systemic disease” arm of the NOMS framework, and guides multidisciplinary teams toward operative, minimally invasive, or nonoperative strategies. Prospective multi center validation is warranted before broad implementation.

Abstract Submission ID: 39

Serum Deprivation Induces Autophagic Flux and Apoptosis in Human Nucleus Pulposus Cells: Implications for Intervertebral Disc Degeneration and Potential Therapeutic Strategy

Jong-Beom Park¹, Young-Yul Kim¹

¹ Department of Orthopaedic Surgery, The Catholic University of Korea College of Medicine, Korea

Introduction: Nutritional deprivation is a critical pathological factor in intervertebral disc degeneration (IVDD), given the disc's avascular nature and its dependence on diffusion through the endplate for nutrient supply. This study investigated the effects of serum deprivation on autophagic flux and apoptosis in human nucleus pulposus (NP) cells, with implications for regenerative strategies in IVDD.

Methods: Huma NP cells were isolated from surgically obtained human disc tissues from surgeries of disc herniations. To simulate progressive nutrient deprivation, NP cells were cultured under varying fetal bovine serum (FBS) concentrations (10%, 1%, and 0%). Morphological changes, cell viability, DNA content, and metabolic activity were evaluated. Western blotting quantified LC3, P62, HMGB1, and cleaved caspase-3. Apoptotic cell populations were measured by fluorescence-activated cell sorting (FACS). Immunofluorescence staining for LC3, P62, and cleaved caspase-3 assessed autophagic and apoptotic localization. RT-qPCR was performed to analyze expression levels of autophagy-related genes (LC3, P62) and apoptosis-related genes (Caspase-3).

Results: Serum deprivation induced marked reductions in NP cell viability, altered morphology, and decreased metabolic activity in a dose- and time-dependent manner, with maximal effects at 48 hours in 0% FBS. Lower serum concentrations triggered increased autophagic activity, evidenced by LC3-II accumulation and P62 degradation, and enhanced expression of LC3 mRNA. Chloroquine treatment confirmed increased autophagic flux by preventing lysosomal degradation of LC3-II. HMGB1 translocated from the nucleus to the cytoplasm under nutrient stress, further supporting autophagy activation. Concurrently, caspase-dependent apoptosis was observed, with elevated cleaved caspase-3 protein and increased Caspase-3 mRNA levels. FACS analysis revealed significant increases in apoptotic cell populations under 0% FBS conditions. Immunofluorescence confirmed co-localization of LC3 and cleaved caspase-3, indicating simultaneous autophagy and apoptosis under nutrient deprivation.

Conclusion: Serum deprivation robustly induces autophagic flux and caspase-dependent apoptosis in human NP cells, highlighting the critical role of nutritional supply in disc cell survival. The interplay between autophagy and apoptosis under nutrient stress may represent a key mechanism in IVDD progression. Clinically, these findings underscore the potential of therapeutic strategies aimed at restoring nutrient microenvironments or modulating autophagy–apoptosis balance—such as enhancing endplate permeability, supplying metabolic substrates, or pharmacologically regulating autophagy—to preserve NP cell viability and promote intervertebral disc regeneration.

Abstract Submission ID: 189

Risk Factors for Early and Late Adjacent Segment Degeneration requiring revision surgery after Lumbar Fusion – are they comparable?

Dr. Dhruv Patel¹, Dr Saumyajit Basu¹, Dr Ayon Ghosh¹, Dr Sunkappa SR¹

¹ Kothari Medical Centre

Introduction: Adjacent segment degeneration (ASDeg) is a common but poorly understood complication following lumbar fusion surgery. It remains uncertain whether this association is a result of the altered biomechanics following the fusion or simply a continuation of the natural progression of degenerative disc disease. To date, no published data exists that identifies the risk factors associated with the need for surgical intervention in early (<5 years) versus late (≥5 years) ASDeg.

Study Design: Retrospective analytical study.

Objectives: To assess the risk factors associated with the development of Early (<5 years) and Late (≥ 5 years) ASD after lumbar fusion surgeries.

Methods: We conducted a retrospective study analysing all lumbar fusion surgeries (≤2 levels) performed at a single center over a span of 25 years. 3873 patients were screened, of which 1023 were excluded and 67 were diagnosed with ASDeg. Demographic, clinical (initial diagnosis, BMD, history of smoking), radiographic (pre-existing disc degeneration and facetal fluid, PI, LL, PT, PI-LL mismatch), and surgical data (type of fusion surgery, fusion levels, floating vs non-floating fusion, and interventions) were compared between the groups.

Results: 25(0.87%) and 42(1.62%) patients were classified as Early- and Late-onset groups respectively. Diagnosis of ASDeg was made at 2.82±1.11 (Early group) and 7.96±2.41 years (Late group) post-operatively. Number of fusion levels, type of fusion, and floating vs non-floating fusion were statistically insignificant. Incidence of ASDeg was more in the proximal segment (n=60, 89.55%) as compared to the distal segment (n=7, 10.44%). Pre-operative pathology at the operated level (p=0.639) and the type of adjacent segment degenerative changes seen late were not significantly different between the groups (p=0.134). Preoperative disc and facet degeneration at adjacent segments showed no significant intergroup difference (p=0.832). Smoking/tobacco use (p=0.024); LL (p=0.0001), PT (p=0.025) and PI-LL Mismatch (p=0.0009) measured after index fusion surgery were statistically significant.

Conclusions: Presence of asymptomatic degenerative changes at the adjacent segment level has no bearing on the timing of development of adjacent segment disease. Smoking/tobacco use is a major contributor to the development of early ASDeg. Additionally, inadequate restoration of lumbar lordosis and pelvic parameters leads to the development of both early and late-onset ASDeg.

Abstract Submission ID: 183

The good, the bad and the ugly: Cervical disc arthroplasty clinical outcomes and complication rates

Lucas Zubillaga ¹ , Maxime Saad ¹ , Mitchell Hansen ²

¹ John Hunter Hospital, Newcastle, Australia

² John Hunter Hospital, Newcastle, Australia, King Street Private Hospital, Newcastle, Australia, University of Newcastle, NSW, Australia

Introduction: Anterior Cervical Disc Arthroplasty (ACDA) offers decompression with motion preservation versus Anterior Cervical Discectomy and Fusion (ACDF) and may reduce adjacent segment degeneration. Long-term risks include osteolysis and heterotopic ossification (HO), which can lead to implant failure and revision. We report outcomes with an unconstrained disc, emphasizing benefits, challenges, and complications.

Study Design: Retrospective cohort of consecutive ACDA cases performed between 2014–2023 at a single center. Data sources included clinical records, standardized patient-reported outcome measures, and dynamic cervical radiographs. Histopathology/microbiology were reviewed when revision occurred.

Objectives: Describe clinical and radiological outcomes and implant survivorship with an unconstrained device at mid-term follow-up. Quantify HO and osteolysis; explore associations with adjacent segment disease and revision; and generate hypotheses regarding contributors to osteolysis, including a potential role for low-grade infection.

Methods: Seventy-nine patients underwent ACDA; 40 with completed ≥5-year follow-up (44 implants) were analysed. Variables included demographics, index level(s), and construct type (stand-alone vs hybrid). Preoperative and serial follow-ups captured pain, disability, and quality-of-life measures, plus dynamic radiographs. Radiographic endpoints were disc height, range of motion, HO grade, and osteolysis grade. Complications, reoperations at index/adjacent levels, and histology/microbiology (when available) were recorded.

Results: Most patients (73%) had single-level ACDA; 25% had two-level (predominantly hybrid) and a small proportion (∼3%) three-level hybrid constructs. At 5 years, 68% of implants retained motion and original disc height was preserved in 75%. High-grade HO (Grade III–IV) occurred in 45% of implants; roughly half of these remained non-fused and functional. Periprosthetic bone changes were frequent (85%), while moderate–severe osteolysis affected 18% of implants. Two implant failures occurred, both at C5–6. Five patients underwent further surgery: two index-level revisions for implant failure and three operations for symptomatic adjacent segment disease at a mean of 4.5 years post-ACDA. In the failure cohort, histology showed chronic inflammation and cultures were positive for Cutibacterium acnes in both. All three patients needing adjacent-level surgery had high-grade HO (Grade III–IV); two had radiographic fusion of the arthroplasty level.

Conclusions: High-grade HO is common after ACDA and appears linked to higher adjacent segment disease risk and worse patient-reported outcomes—particularly when Grade IV HO results in functional fusion, potentially negating ACDA’s motion-preserving intent. Lower-grade HO showed fewer clear associations. Periprosthetic bone loss was usually indolent; fewer than 5% developed severe osteolysis requiring surgery. Progressive symptoms (e.g., dysphagia, dysphonia) in failures underscore the need for ≥5-year surveillance, even when asymptomatic. Chronic inflammation and C. acnes in failures support a hypothesis that low-grade infection may contribute to osteolysis and implant failure, warranting further study.

Abstract Submission ID: 43

Perioperative Denosumab Versus Bisphosphonate for Midlf Surgery in Patients with Osteopenia: A Prospective Cohort Study

Huang Changsheng ¹ , Yue Lei ¹ , Wang Shijun ¹ , Sun Haolin ²

¹ Department of Orthopedic, Peking University First Hospital, Beijing, China

² Department of Orthopedic, Peking University First Hospital

Introduction: Lumbar degenerative diseases (LDD) like lumbar spinal stenosis and spondylolisthesis are prevalent in the elderly. Pedicle screw instrumentation and fusion surgery, such as midline lumbar fusion (MIDLF) with cortical bone trajectory (CBT) screw fixation, are effective treatments. However, osteoporosis elevates risks of screw loosening and fusion failure. Anti-osteoporosis drugs (e.g., bisphosphonates, teriparatide, denosumab) are used, but teriparatide is costly and bisphosphonates have side effects. Denosumab’s perioperative use for MIDLF fusion is understudied, prompting this research.

Study Design: Prospective Cohort Study

Objectives: To compare the effectiveness and safety of perioperative denosumab, bisphosphonates, and a control group in promoting lumbar fusion after MIDLF surgery in patients with osteopenia or osteoporosis.

Methods: This prospective cohort study enrolled 54 patients with osteopenia or osteoporosis undergoing MIDLF surgery. Patients were divided into three groups: denosumab (60 mg subcutaneous injection), bisphosphonates (5 mg intravenous infusion), and control (no additional treatment). Outcomes included fusion rates, clinical scores, bone metabolism markers, and adverse events.

Results: 54 patients were included in the study. Among them, 50 patients completed the 6-month postoperative follow-up. Due to the impact of the COVID-19 pandemic, only 29 patients completed the final follow-up. At six months, fusion rates were significantly higher in the denosumab (25% complete, 68.6% partial) and bisphosphonate (25% complete, 75% partial) groups compared to the control group (10.5% complete, 57.9% partial, P<0.01). No significant difference was found between the two drug groups. Postoperative fever was more common in the bisphosphonate group (71.4%) than in the denosumab (11.8%, P=0.004) and control (23.5%, P = 0.011) groups.

Conclusions: In the short-term follow-up, both denosumab and bisphosphonates significantly improved the early bone fusion rate after MIDLF surgery, with no significant difference observed between the two. Denosumab was associated with a lower incidence of postoperative fever, making it a recommended choice for perioperative anti-osteoporosis therapy.

Abstract Submission ID: 70

The radiographic, pulmonary, and clinical outcomes of patients with severe rigid spinal deformities treated via halo-pelvic traction

Tianyuan Zhang ¹ , Jian Chen ¹ , Yaolong Deng ¹ , Wenyuan Sui ¹ , Jingfan Yang ¹ , Zifang Huang ² , Junlin Yang ¹

¹ Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China

² The 3rd Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

Introduction: The severe rigid deformity patients with pulmonary dysfunction could not tolerate complicated corrective surgery. Preoperative traction is used to reduce the curve magnitude and improve the pulmonary function before surgery, including halo-gravity traction (HGT) and halo-pelvic traction (HPT).

Study Design: A retrospective study.

Objectives: The present study aimed to retrospectively compare the radiographic, pulmonary and clinical outcomes of preoperative HGT and HPT in severe rigid spinal deformity with respiratory dysfunction.

Methods: 81 cases of severe rigid kyphoscoliosis treated with preoperative traction prior to corrective surgery for spinal deformity between 2016 and 2019 were retrospectively reviewed. Two patient groups were compared, HPT group (N = 30) and HGT group (N = 51). Patient demographics, coronal and sagittal Cobb angles and correction rates, pulmonary function, traction time, osteotomy grade, and postoperative neurological complications were recorded for all cases.

Results: The coronal Cobb angle was corrected from 140.67 ± 2.63 to a mean of 120.17 ± 2.93° in the HGT group, and from 132.32 ± 4.96 to 87.59 ± 3.01° in the HPT group (mean corrections 15.33 ± 1.53 vs. 34.86 ± 3.11 %) (P = 0.001). The mean major sagittal curve decreased from 134.28 ± 3.77 to 113.03 ± 4.57° in the HGT group and from 129.60 ± 8.45 to 65.61 ± 7.86° in the HPT group (P < 0.001); the mean percentage corrections were 16.50 ± 2.13 and 44.09 ± 9.78 % (P < 0.001). A significant difference in the pulmonary function test results was apparent between the two groups; the mean improvements in the FVC% of the HGT and HPT groups were 6.76 ± 1.85 and 15.6 ± 3.47 % (P = 0.024). The HPT group tended to exhibit more FEV% improvement than the HGT group, but the difference was not significant (5.15 ± 2.27 vs. 11.76 ± 2.22 %, P = 0.91).

Conclusions: Patients with severe rigid kyphoscoliosis who underwent preoperative HPT exhibited better radiographic correction of the deformity, and pulmonary function, and required fewer osteotomies compared to the HGT group. Thus, HPT may be useful for severe rigid spinal deformity patients with pulmonary dysfunction.

Abstract Submission ID: 69

A Novel Graded Surgical Strategy for Scoliosis Correction in Spinal Muscular Atrophy Patients with Severe Respiratory Dysfunction

Tianyuan Zhang ¹ , Wenyuan Sui ¹ , Yaolong Deng ¹ , Jingfan Yang ¹ , Zifang Huang ² , Junlin Yang ¹

¹ Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China,

² The 3rd Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

Introduction: Severe respiratory dysfunction (SRD) has historically been considered a contraindication for scoliosis surgery due to significant life-threatening risks. Patients with spinal muscular atrophy (SMA) frequently develop severe spinal deformities alongside SRD, presenting a formidable challenge clinically.

Study Design: A retrospective study.

Objectives: This study introduces a novel graded surgical strategy designed to safely and effectively correct scoliosis in SMA patients with SRD.

Methods: From 2018 to 2023, SMA patients with SRD who underwent scoliosis correction surgery at our center were consecutively enrolled. A multidisciplinary team meticulously assessed perioperative risks and developed a graded surgical approach based on the severity of each patient’s condition. For grade A strategy, high-all-pedicle-screws constructs were commonly used. For grade B, pedicle screws were used in the convex side and a Domino connecter was used to connect proximal and distal rod in the concave side. For grade C, only a Domino connecter, were applied in the concave side with proximal and distal anchors. As the patient's condition worsened, the surgical strategy evolved from A to C. Clinical data, surgical details, and postoperative outcomes were systematically analyzed.

Results: A total of 40 patients were included in this study. The mean age was 19.23±8.09 years. All subjects were diagnosed as SRD with percentage forced expiratory volume in one second (FEV1%) averaging 38.76±13.22%. The scoliosis, kyphosis, and pelvic obliquity angle averaged 116.40±18.35°, 101.52±41.54°, and 33.65±14.30° before surgery. 12 cases underwent grade A strategy, 24 cases grade B, and 4 cases grade C. Patients with less invasive surgical strategy had worse overall conditions, including nutritional status and respiratory function (P<0.001). Postoperatively, it decreased to 50.55±21.12°, 41.48±18.29°, and 14.86±11.46°, respectively. All patients showed improved sitting ability and pelvic balance after surgery. No mechanical complications were reported during 2-year follow-up.

Conclusions: This study proposed a novel graded surgical strategy for scoliosis correction based on different severity stratifications of SMA patients with SRD. This strategy could provide sufficient spinal and pelvic correction and recover patients’ sitting balance while ensuring perioperative safety and limiting the risks of respiratory complications.

Abstract Submission ID: 159

A Comparative Radiological Study of three Minimally Invasive techniques- Oblique Lumbar Interbody Fusion, Transkambin Facet-Sparing Lumbar Interbody Fusion and Transforaminal Lumbar Interbody Fusion: Effect on disc height, segmental lordosis and lumbar lordosis.

Sharvin Sheth ¹ , Amit Jhala ¹ , Akash Vasavda ¹ , Harsh Kotecha ¹

¹ Dept. of Spine Surgery, HCG Hospitals, Ahmedabad

Introduction: Oblique Lumbar Interbody fusion-anterior to psoas (OLIF-ATP), Facet-sparing Transkambin Lumbar Interbody Fusion (KLIF) and Transforaminal Lumbar Interbody Fusion (TLIF) are the commonly practiced minimally invasive techniques for lumbar spinal fusion. Adequate restoration of disc height (DH), segmental lordosis (SL) and lumbar lordosis (LL) is crucial in restoring spinal biomechanics and improve clinical outcomes.

Study Design: Retrospective

Objectives: The aim of our study was to compare and evaluate the restoration of aforementioned radiological parameters in these three techniques.

Methods: This was a retrospective study. Patients with foraminal stenosis, lumbar canal stenosis and spinal instability (Myerding grade I-II) , who had undergone minimally invasive OLIF-ATP, KLIF or TLIF, with a minimum follow-up of three months were included in our study. Trauma, tumours, infections and revision spine surgeries were excluded. Disc height, segmental lordosis, and lumbar lordosis were measured in pre-operative and post operative radiographs on Surgimap software. Appropriate statistical analysis was done to compare the restoration of radiological parameters in all three techniques. Clinical evaluation was done using Modified Macnab’s grading, and VAS scores for back and leg pain.

Results: A total of 126 patients were enrolled in the study. 35 patients had undergone OLIF-ATP, 41 patients had undergone KLIF while 50 patients had undergone TLIF; 50 segments in each group. The mean age and gender distribution were statistically comparable between all groups (p>0.05). Most of the patients enrolled in each were females (65.71% in OLIF group, 70.73% in the KLIF group, and 52% in the TLIF group). The mean change in the segmental lordosis angle was noted to be significantly greater in the OLIF-ATP group versus both, the KLIF and the TLIF group (5.36+/-2.56 in OLIF group, versus 3.16+/-2.15 in KLIF group and 3.60+/-2.05 in TLIF group). The mean change in lumbar lordosis was 3.79+/-2.64 in OLIF group, 2.73+/-2.16 in KLIF group and 4.26+/-1.53 in TLIF group. The mean percentage change in the disc height was noted to be significantly greater in the OLIF group versus the KLIF and the TLIF group (103.41 + 88.55 in OLIF group versus 58.25 + 49.28 in KLIF group and 44.25 + 38.31 in TLIF group). The clinical outcomes were comparable.

Conclusions: OLIF-ATP, KLIF, and TLIF are effective minimally invasive techniques of lumbar spinal fusion surgery with adequate restoration of disc height, segmental lordosis and lumbar lordosis. Our study demonstrated that OLIF gives better restoration of disc height and segmental lordosis. This can be attributed to the large interbody spacers with lordotic design placed more anteriorly in the disc space, thus allowing a more anterior fulcrum to restore lordosis when compression manoeuvre is applied on pedicle screws. However, the change in lumbar lordosis is comparable in TLIF and OLIF groups, but less in KLIF group. Furthermore, the clinical outcomes of OLIF, KLIF and TLIF are comparable among all three groups. This also shows the importance of appropriate patient selection for each technique for adequate lordosis restoration and maintaining spinopelvic balance.

Abstract Submission ID: 88

Development and Validation of a Novel Radiological Scoring System for Craniovertebral Junction Tuberculosis: Correlation with Disease Severity and Treatment Outcomes

Dr Chitranshu Shrivastava ¹ , Dr Tushar Rathod ¹ , Dr Rushikesh Sahade ¹ , Dr Akshay Mohite ¹

¹ Seth GS Medical College and KEM Hospital

Introduction: Craniovertebral junction (CVJ) tuberculosis is a rare but serious manifestation of spinal tuberculosis, accounting for less than 1% of all cases. It presents with a wide spectrum of clinical and radiological manifestations, ranging from mild neck pain to severe neurological deficits due to upper cervical spinal cord compression. The management of CVJ tuberculosis remains controversial, particularly in cases with significant instability but no neurological deficits. By incorporating key clinical and radiological parameters, this system aims to provide a structured approach to assessing disease severity and guiding appropriate management strategies. This study aims to introduce a novel radiological scoring system for objective decision-making in CVJ tuberculosis management by evaluating disease severity and guiding appropriate treatment strategies.

Study Design: Prospective observational study.

Objective: To develop and validate a novel radiological scoring system for craniovertebral junction (CVJ) tuberculosis to guide objective treatment decision-making.

Methods: Thirty patients with CVJ tuberculosis were prospectively enrolled over 18 months at a tertiary care centre. Clinical and radiological assessments, including X-rays, CT(Computed Tomography), and MRI(Magnetic Resonance Imaging), were performed at baseline and at 3-, 6-, and 9-month follow-ups. Neurological status was graded using the ASIA Impairment Scale, disability with the Neck Disability Index (NDI), and myelopathy severity with the modified Japanese Orthopaedic Association (mJOA) scale. A 12-point radiological scoring system was developed, incorporating bony destruction, instability, cord compression, and neurological deficit. Patients with scores <8 were managed conservatively, while those with scores >8 underwent surgery. Reliability and validity were evaluated using Cronbach’s α, Kaiser-Meyer-Olkin (KMO) measure, Bartlett’s test, and principal component analysis (PCA).

Results: Of the 30 patients,49% had neurodeficit at baseline. At 6 months follow up 81.48% improved to ASIA E. According to the novel radiological score, patients with a score <8 (17 cases) were managed conservatively, while those with scores >8 (13 cases) required surgical intervention. Surgical patients had significantly higher scores for instability, cord signal changes, and neurological impairment. At 6 months, the mean mJOA score improved from 11.17 to 14.07, and NDI decreased from 39.86 to 29.19, indicating better functional outcomes. At 6 months, Radiological parameters also showed significant improvement, including increased space available for the cord (SAC) and reduced atlanto-dens interval (ADI). Statistical analysis revealed a strong correlation between radiological score and management strategy (p<0.001). The four-item Radiological Scale was assessed for reliability and validity. Cronbach’s alpha (0.776) indicated good internal consistency. Construct validity was supported by a Kaiser-Meyer-Olkin value of 0.811 and Bartlett’s test (p < 0.001). Principal Component Analysis identified a single factor (eigenvalue = 2.721) explaining 68.033% of variance, with strong factor loadings (≥ 0.763). These results confirm the scale as a reliable and valid assessment tool.

Conclusion: The proposed radiological scoring system provides a structured approach to evaluating CVJ tuberculosis severity, effectively guiding conservative or surgical management decisions. This system facilitates individualized treatment planning, optimizing patient outcomes by guiding appropriate treatment strategies. Further validation in larger cohorts is recommended to refine its clinical applicability.