Loss to long-term follow-up in children with spinal tuberculosis: a retrospective cohort study at a tertiary hospital in the Western Cape, South Africa

Abstract

Introduction children with spinal tuberculosis (TB) are at risk of kyphotic deformity both during and after the active phase of the disease. Management guidelines include follow-up until skeletal maturity. Little is known about adherence to this recommendation. This study aimed to investigate loss to long-term spine clinic follow-up (LTFU) among children with spinal TB at a tertiary hospital in the Western Cape Province, South Africa. Methods this retrospective cohort study included all children diagnosed with spinal TB at Tygerberg Hospital between January 2012 and December 2015. Spine clinic follow-up was investigated for five years following diagnosis. Relevant surgical interventions and re-presentation were evaluated until 31 st December 2020. Results thirty-two children, median age 6 years (range 1-14 years), were diagnosed with spinal TB and intended for spine clinic follow-up. Twenty-seven (84%) children were LTFU within five years of diagnosis with 16 (50%) LTFU within 10.5 months. Among children in follow-up, one child had further surgery for progression of deformity two years from diagnosis and one child had further surgery for new-onset neurological deficit eight years from diagnosis. Conclusion most children with spinal TB did not receive the recommended follow-up until skeletal maturity. Without further data on these children, the clinical significance of this LTFU could not be evaluated. Further studies are needed to investigate sequelae during skeletal maturation in the context of current management for paediatric spinal TB.

Navigating Perioperative Challenges in Pott’s Spine: A Comprehensive Review

“…Additionally, sensory re-education assumes a crucial role in the rehabilitation of individuals afflicted with Pott's disease [39]. Evidence suggests that diverse modalities, including transcutaneous electrical neuromuscular stimulation, aquatic therapy, overground training (walking program), aerobic exercise, and trunk strengthening interventions, can yield noteworthy reductions in pain, psychological distress, and disability among patients with Pott's disease [40]. Moreover, physiotherapy management holds particular significance in the post-spinal decompression surgery and post-spinal fusion surgery phases of Pott's spine treatment.…”

“…Moreover, physiotherapy management holds particular significance in the post-spinal decompression surgery and post-spinal fusion surgery phases of Pott's spine treatment. Interventions such as spinal stabilization exercises, Maitland techniques, back school programs, and targeted exercise and strengthening interventions have demonstrated notable efficacy in improving global outcomes for individuals grappling with Pott's disease [40].…”

“…Following the completion of tuberculosis treatment, it is customary for children who have recovered from spinal tuberculosis to undergo annual follow-up visits at the hospital until they reach skeletal maturity [41]. This proactive approach stems from the heightened risk of deformity progression even years after the resolution of the infection in pediatric cases, necessitating ongoing monitoring to track skeletal development [40]. However, despite being a standard protocol, a recent study revealed a significant gap between recommended practice and real-world implementation, with a striking 84% of children diagnosed with spinal tuberculosis failing to receive the prescribed follow-up care [41].…”

Clinical standards for drug-susceptible TB in children and adolescents

“… 5 Children and adolescents with spinal TB should be evaluated at least annually until they reach skeletal maturity to check for potential progressive deformity, which could lead to neurological, cardiopulmonary, orthopaedic and psychological complications. 67 Children and adolescents with TBM should be assessed throughout treatment and thereafter, and referred as early as possible for multidisciplinary care to manage sequelae, including feeding issues, mobility issues, hearing and vision loss, neurocognitive impacts and endocrinopathies. 68 They should also receive ongoing educational evaluation and appropriate educational support.…”

Tumors and infections of the growing spine

“… 105 , 107 , 109 Regarding kyphotic deformity, the orthopedists are more unanimous; this problem is very important as a late sequela of ST and a crucial component of the natural history of ST, especially in the growing spine. 107 , 110 Neurologic deficits associated with kyphotic deformity can be slowly increasing (due to gradual spinal cord compression) or rapidly occurring (deformity leading to an instability episode). A special group of patients are children with “spine-at-risk” signs, with risk of deformity progression and neurologic failure during the growth period.…”