Spinal deformity after childhood surgery for tuberculosis of the spine. A comparison of radical surgery and debridement

Upadhyay, S. S.; Saji, M. J.; Sell, P; Sell, B.; Hsu, LC

doi:10.1302/0301-620x.76b1.8300690

Cited by 44 publications

(32 citation statements)

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“…Kyphosis did not increase in the late post-operative phase in our series, probably due to the fact that interbody bony fusion occurred in all patients within a few months post-operatively and further vertebral collapse did not occur after this point. Chances of continued progression of kyphosis are increased in the presence of longer segment disease involvement, healing by fibrous ankylosis than with bony ankylosis and in children [34,50]. Since our series did not include skeletally immature children, we cannot comment on the suitability of the procedure in this age group.…”

Section: Discussionmentioning

confidence: 94%

Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting

Kumar¹,

Joseph²,

Manur³

2012

Eur Spine J

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Purpose The aim of this prospective study is the analysis of the clinical and radiological outcomes of active thoracolumbar spinal tuberculosis treated with isolated posterior instrumentation without any posterior bone grafting or anterior inter-body bone grafting or anterior instrumentation. Methods The study was a prospective follow-up of 25 patients with active thoraco-lumbar spinal tuberculosis who underwent posterior spinal instrumentation with pedicle screws and rods. These patients had posterior stabilization of the involved segment of the spine without anterior or posterior bone grafting. The mean duration of follow-up was 3.3 years and the minimum duration of follow-up was 2 years. Results The mean kyphotic angle improved from 32.4°p re-operatively to 7.2°in the early follow-up period. Following a minor loss of correction during follow-up, the mean kyphotic angle settled at 11.5°at the time of final follow-up. Inter-body bony fusion was noticed at the final follow-up in all patients despite the absence of anterior bone grafting or cages. Conclusion Posterior instrumented stabilization followed by chemotherapy seems to be adequate for obtaining satisfactory healing of the lesions. Anterior inter-body bony arthrodesis occurs despite the absence of anterior bone grafts or cages. Careful patient selection is critical for successful outcome with this technique.

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Section: Discussionmentioning

confidence: 94%

Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting

Kumar¹,

Joseph²,

Manur³

2012

Eur Spine J

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“…However, bone lesions in children heal and model much faster than those of the adults. The growth cartilage in children is relatively well preserved in the tuberculous lesions and it is radically excised during radical resection of the lesion 1258…”

Section: Introductionmentioning

confidence: 99%

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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“…It has been reported that the long-term outcome of the deformity was similar when comparing the results of treatment with anterior fusion with those of debridement. 7,[21][22][23][24][25][26][27] This may be due to the instability being inadequately addressed by anterior surgery alone, although subsequent remodelling has been widely documented. These considerations have led us to the understanding that various types of lesion require different surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis of the thoracic spine

Mehta

Bhojraj

2001

The Journal of Bone and Joint Surgery. British volume

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In spinal tuberculosis MRI can clearly demonstrate combinations of anterior and posterior lesions as well as pedicular involvement. We propose a classification system, using information provided by MRI, to help to plan the appropriate surgical treatment for patients with thoracic spinal tuberculosis. We describe a series of 47 patients, divided into four groups, based on the surgical protocol used in the management. Group A consisted of patients with anterior lesions which were stable with no kyphotic deformity, and were treated with anterior debridement and strut grafting. Group B comprised patients with global lesions, kyphosis and instability who were treated with posterior instrumentation using a closed-loop rectangle with sublaminar wires, and by anterior strut grafting. Group C were patients with anterior or global lesions as in the previous groups, but who were at a high risk for transthoracic surgery because of medical and possible anaesthetic complications. These patients had a global decompression of the cord posteriorly, the anterior portion of the cord being approached through a transpedicular route. Posterior instrumentation was with a closed-loop rectangle held by sublaminar wires. Group D comprised patients with isolated posterior lesions which required posterior decompression only.An understanding of the extent of vertebral destruction can be obtained from MRI studies. This information can be used to plan appropriate surgery. Tuberculosis causes three million deaths each year, and 90 million new cases have been diagnosed in the last ten years.

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Spinal deformity after childhood surgery for tuberculosis of the spine. A comparison of radical surgery and debridement

Cited by 44 publications

References 0 publications

Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting

Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting

Spinal tuberculosis in children: Retrospective analysis of 124 patients

Tuberculosis of the thoracic spine

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