Surgical Management of Paediatric Thoracolumbar Tuberculosis by a Combination of Anterior and Posterior Versus Posterior Only Approach: A Systematic Review and Meta-Analysis

Upadhyaya, Gaurav Kumar; Sami, Abdus; Patralekh, Mohit Kumar; Agarwal, Anil; Iyengar, Karthikeyan P; Aryal, Aayush; Bhagwati, Pragya; Garg, Bhavuk; Jain, Vijay Kumar

doi:10.1177/21925682221090478

Cited by 4 publications

(1 citation statement)

References 33 publications

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“…On MR imaging, a well-defined paraspinal region with abnormal signal intensity; a thin, smooth abscess wall; subligamentous spread to three or more vertebral levels; and multiple vertebral involvement are more suggestive of tuberculous spondylitis than of pyogenic spondylitis. Bone fragments in the intra-and/or extra-spinal soft tissues have been described as characteristic of spinal tuberculosis together with gibbous deformity and severe vertebral collapse, even if these features are most evident in the later stages, when the surgeon has to manage the outcomes [43][44][45].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Approach and Differences between Spinal Infections and Tumors

Compagnone,

Cecchinato,

Pezzi

et al. 2023

Diagnostics

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Study design: A systematic review of the literature about differential diagnosis between spine infection and bone tumors of the spine. Background and Purpose: The differential diagnosis between spine infection and bone tumors of the spine can be misled by the prevalence of one of the conditions over the other in different areas of the world. A review of the existing literature on suggestive or even pathognomonic imaging aspects of both can be very useful for correctly orientating the diagnosis and deciding the most appropriate area for biopsy. The purpose of our study is to identify which imaging technique is the most reliable to suggest the diagnosis between spine infection and spine bone tumor. Methods: A primary search on Medline through PubMed distribution was made. We identified five main groups: tuberculous, atypical spinal tuberculosis, pyogenic spondylitis, and neoplastic (primitive and metastatic). For each group, we evaluated the commonest localization, characteristics at CT, CT perfusion, MRI, MRI with Gadolinium, MRI diffusion (DWI) and, in the end, the main features for each group. Results: A total of 602 studies were identified through the database search and a screening by titles and abstracts was performed. After applying inclusion and exclusion criteria, 34 articles were excluded and a total of 22 full-text articles were assessed for eligibility. For each article, the role of CT-scan, CT-perfusion, MRI, MRI with Gadolinium and MRI diffusion (DWI) in distinguishing the most reliable features to suggest the diagnosis of spine infection versus bone tumor/metastasis was collected. Conclusion: Definitive differential diagnosis between infection and tumor requires biopsy and culture. The sensitivity and specificity of percutaneous biopsy are 72% and 94%, respectively. Imaging studies can be added to address the diagnosis, but a multidisciplinary discussion with radiologists and nuclear medicine specialists is mandatory.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Approach and Differences between Spinal Infections and Tumors

Compagnone,

Cecchinato,

Pezzi

et al. 2023

Diagnostics

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Surgery for deformities in pediatric spinal tuberculosis: single centre review of 51 cases

Basu,

Maddali

2024

Spine Deform

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Posterior instrumentation combined with anterior debridement and reconstruction using allogenic strut bone for the treatment of children with multilevel lumbar spinal tuberculosis: minimum 5-year follow-up

Wang

Zhang

et al. 2022

BMC Musculoskelet Disord

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Objectives To evaluate the clinical outcomes of one-stage posterior instrumentation combined with anterior debridement and reconstruction using allogenic strut bone for the surgical treatment of multilevel lumbar spinal tuberculosis in children younger than 10 years of age with at least 5 years of follow-up. Methods A total of 16 children with multilevel lumbar spinal tuberculosis who underwent one-stage posterior instrumentation combined with anterior debridement and reconstruction using allogenic strut bone were enrolled from January 2003 to January 2017. Among them, 6 were females and 10 were males with an average age of 6.9 ± 2.2 years (range 3–10 years). Patients’ clinical outcomes, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), kyphosis angle, and neurologic function, were assessed before and after surgery. P < 0.05 was considered statistically significant. Results The average follow-up was 7.8 ± 2.4 years. CRP and ESR of all patients returned to the normal range within 1 year. Compared with preoperative neurological deficits, postoperative and final follow-up neurological deficits improved significantly by grades 0.9 and 1.6, respectively. No instrumentation failure occurred, and all patients achieved solid bone fusion. The preoperative kyphosis angle was 29.9 ± 8.1°, which decreased significantly to 5.9 ± 2.6° postoperatively. There was a mild loss (2.5°) and the kyphosis angle was 8.4 ± 2.9° at final follow-up, with an overall correction rate of 71.3%. Conclusion One-stage posterior instrumentation combined with anterior debridement and reconstruction using allogenic strut bone is a safe and effective procedure for children with multilevel lumbar spinal tuberculosis. This approach facilitates the removal of lesions and decompression of the spinal cord and is effective in restoring spinal stability, correcting kyphosis, and preventing deterioration of the deformity.

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Surgical Management of Paediatric Thoracolumbar Tuberculosis by a Combination of Anterior and Posterior Versus Posterior Only Approach: A Systematic Review and Meta-Analysis

Cited by 4 publications

References 33 publications

Diagnostic Approach and Differences between Spinal Infections and Tumors

Diagnostic Approach and Differences between Spinal Infections and Tumors

Surgery for deformities in pediatric spinal tuberculosis: single centre review of 51 cases

Posterior instrumentation combined with anterior debridement and reconstruction using allogenic strut bone for the treatment of children with multilevel lumbar spinal tuberculosis: minimum 5-year follow-up

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