Conservative treatment of tuberculosis of the thoracic and lumbar spine in adults and children

Moon, Myung-Sang; Kim, I; Woo, Young Kyun; Park, Y O

doi:10.1007/bf00271307

Cited by 77 publications

(62 citation statements)

References 29 publications

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“…Both regimens were proven equally effective in the current series. The disease healing pattern coincided with that of the previous other reports 48…”

Section: Discussionsupporting

confidence: 89%

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Spinal tuberculosis in children: Retrospective analysis of 124 patients

Moon

Kim

Lee

et al. 2012

IJOO

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Background:There is a paucity of report on spinal tuberculosis in children. We report a retrospective analysis of 124 children with TB spine treated over 30 years.Materials and Methods:We retrospectively reviewed 124 children; of cervical (n=36), cervicothoracic (n=4), thoracic (n=53), and lumbar and lumbosacral tuberculosis (n=31) with no skip or multifocal lesions treated between 1971-2004. The age ranged from 2 to 15 years of age with 28 children less than 5 years of age, 58 were between 6 and 10 years, and 38 were over 10 years, 18 had paraplegia of various degrees. Ninety-one children were treated conservatively, while 33 children were subjected to surgery for focal debridement (n=23), posterior interspinous wiring and cementation (n=4), and posterior instrumentation with rods and segmental wiring (n=14). Triple chemotherapy (isoniazid, streptomycin, and PAS) was given for 18 months (3HSPa, 15Hpa) between 1971 and 1975, and triple or quadruple chemotherapy (isoniazid, rifampicin, ethambutol, or pyrazinamide) after 1976 to 2004 for 12 months (12RHZ or 12 RHZE). Some of the children in the current series belonged to the British MRC conservative study patients. The average duration of followup was 5 years and 8 months (range 1.6-20 years).Results:All children attained healed status and showed neural recovery (n=18). The patients attained healed status at 18 months in the first series and at 12 months in the second series after chemotherapy. Spontaneous intercorporal fusion occurred only in 10 (8.06%) of 124 children. Sagittal curve during growth showed three different patterns: Unchanged, decreased, and increased curves. The residual kyphosis was unavoidable in cases with growth plate damage. Kyphosis increased in cases with wedged monovertebra and fused wedged block vertebra, though it was different at different level.Conclusion:The vertebral reformation and curve correction were possible only through the growth plates. The posterior instrumented stabilization alone could correct and/or prevent progress of the kyphosis. However, for active tuberculosis, posterior instrumented stabilization combined with anterior radical surgery should be reserved only for the advanced tuberculosis with instability, rapid progress of kyphosis, and/or unacceptable pre-existing kyphosis, though there is a new trend of prophylactic posterior instrumentation even for the early tuberculosis.

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“…Both regimens were proven equally effective in the current series. The disease healing pattern coincided with that of the previous other reports 48…”

Section: Discussionsupporting

confidence: 89%

“…Tuberculous spinal deformity in children can be corrected spontaneously during growth when the end-plate and apophyseal ring cartilage are preserved,49 whereas in the adults, the established deformities do not correct spontaneously. Also, children's deformed spine morphology are affected by the altered biomechanics 610…”

Section: Introductionmentioning

confidence: 99%

Spinal tuberculosis in children: Retrospective analysis of 124 patients

Moon

Kim

Lee

et al. 2012

IJOO

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“…Although chemotherapy is highly effective in controlling tubercular infection, patients treated with chemotherapy alone have an average increase of 15°in deformity [1,2] and 3% to 5% of the patients develop kyphosis greater than 60° [3][4][5]. A severe kyphosis can lead to immense cosmetic and psychological disturbance in growing children and can result in costo-pelvic impingement, secondary cardio-respiratory problems and late-onset paraplegia [5].…”

Section: Introductionmentioning

confidence: 99%

Kyphotic deformity in spinal tuberculosis and its management

Rajasekaran

2012

International Orthopaedics (SICOT)

130

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Spinal tuberculosis is the most common cause of severe kyphosis in many parts of the world. Three percent of patients treated conservatively end up with a deformity greater than 60 degrees which can cause serious cosmetic, psychological, cardio-respiratory and neurological problems. Severe kyphotic deformities are usually the result of childhood spinal deformities and 'Spine at risk' radiological signs are helpful to identify children at risk of deformity. In children, a severe type of collapse, termed as 'Buckling Collapse' is also noted where the kyphosis is more than 120 degrees. Risk factors for buckling collapse include an age of less than seven years at the time of infection, thoracolumbar involvement, loss of more than two vertebral bodies and the presence of radiographic 'Spine-at-risk' signs. In correction of established deformity, posterior only surgery with a variety of osteotomies is now preferred. In patients with deformity of more than 90 degrees, an opening-closing wedge osteotomy must be done to prevent neurological deficit.

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“…The high success of disease cure achieved with the powerful anti-tuberculous drugs has made uncomplicated spinal tuberculosis a 'medical disease' [6][7][8][9]. Although chemotherapy is effective in inactivating the disease, the vertebrae collapse till the healthy vertebral bodies in the region of the kyphosis meet anteriorly and consolidate.…”

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confidence: 99%

Closing–opening wedge osteotomy for severe, rigid, thoracolumbar post-tubercular kyphosis

2010

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Childhood spinal tuberculosis, especially when associated with severe vertebral destruction of more than two vertebral bodies can end up in severe deformity. These children show progressive deformity throughout the period of growth and can develop severe kyphosis of [100°. Such kyphosis is severely disabling with significant risk of neurological deficit and respiratory compromise. Surgical correction of these deformities by both anterior and posterior approaches has been described but each have serious limitations of approach, correctability and safety. We describe here a technique of posterior closing-anterior opening osteotomy, which allowed us to correct a rigid post-tubercular deformity of 118°in a 13-year-old boy with neglected spinal tuberculosis. The patient was a 13-yearold boy, who had contracted spinal tuberculosis at the age of 6 years. Although the disease was cured by anti-tubercular chemotherapy, he continued to deteriorate in deformity and presented to us with severe thoracolumbar kyphosis (118°). He was neurologically intact but was beginning to show shortness of breath on exertion. Patient also had fore shortening of the trunk with impingement of the rib cage on the iliac crest. Radiographs revealed complete destruction of T12, L1 and L2 vertebral bodies with the T11 vertebra fusing with L3 anteriorly. CT scans and MRI revealed severe collapse of the vertebral column and the spinal cord being stretched over the 'internal gibbus', which was formed by the remnants of the destroyed vertebrae. A single stage closing-opening osteotomy was done by a midline posterior approach with continuous intraoperative spinal cord monitoring. The procedure involved extensive laminectomy of T11-L2, pedicle screw fixation of three levels above and three levels below the apex, a wedge osteotomy at the apex of the deformity from both sides, anterior column reconstruction by appropriate-sized titanium cage and gradual correction of deformity by closing the posterior column using the cage as a fulcrum. This allowed us to achieve a correction to 38°(68% correction). There was no intraoperative or perioperative adverse event and patient had good functional and Electronic supplementary material The online version of this article

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Conservative treatment of tuberculosis of the thoracic and lumbar spine in adults and children

Cited by 77 publications

References 29 publications

Spinal tuberculosis in children: Retrospective analysis of 124 patients

Spinal tuberculosis in children: Retrospective analysis of 124 patients

Kyphotic deformity in spinal tuberculosis and its management

Closing–opening wedge osteotomy for severe, rigid, thoracolumbar post-tubercular kyphosis

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