Spinal tuberculosis in children: Retrospective analysis of 124 patients

Abstract

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.

360-degree cervical spinal arthrodesis for treatment of pediatric cervical spinal tuberculosis with kyphosis

“…Especially in recent years, the prevalent application of the cervical anterior plate can provide immediate stability and maintain intervertebral height and cervical lordosis reconstruction; which could prevent graft or interbody support sliding, increase fusion rate, and reduce the relapse of tuberculosis. However, anterior radical curettage and excision of the ring apophysis and end-plate in pediatric CST destroys anterior growth and restricts the capacity for spinal remolding; contributing to the progressive development of kyphosis during growth [ 10 , 11 , 18 ]. Therefore, PCSTK treatment should not only aim to cure the affection, but also aim to correct and maintain cervical stability and sagittal alignment by preventing the additional progression of bony destruction and equilibrating growth potential during the treatment period.…”

Tubercular spondylitis in children

“…The incidence of spinal tuberculosis in children is variable. It is reported as 58% of all spine tuberculosis in Korea, 1/3 rd of all patients as reported from Chennai (India) and 26% in Hong Kong 1112131415. It produces severe bone loss as well as growth affection; hence the sequelae are serious.…”

Pott’s Disease in a 3 Years Old Italian Child: Case Report and Review of the Literature

“…Considering Asian studies, in a retrospective wide and long-term review (between 1971 to 2004), Myung-Sang M. et al [12] described characteristics and management of 124 children with spinal tuberculosis aged 2 to 15 years old in an orthopedic surgery department of a South Korean isle (Jeju). [13] reviewed all patients less than 14 years old with central nervous system or spinal tuberculosis diagnosed in a tertiary care center in Saudi Arabia over a 20 years-period.…”