Top

Acta Neurochirurgica

Published in:

01-12-2024 | Tuberculosis | Original Article

Posterior fixation, anterior debridement and bone grafting in the treatment of thoracic and lumbar tuberculosis in children younger than 3 years of age

Authors: Shutao Gao, Yakefu Abulizi, Fulati Mamat, Mardan Mamat, Weidong Liang, Hailong Guo, Chuanhui Xun, Weibin Sheng

Published in: Acta Neurochirurgica | Issue 1/2024

Abstract

Purpose

This study aimed to investigate the clinical outcomes of posterior fixation, combined with one- or two-stage anterior debridement and bone grafting in treating children younger than 3 years of age with thoracic and lumbar tuberculosis.

Methods

This was a retrospective study involving 16 young children with thoracic or lumbar tuberculosis. Surgical data were recorded. Frankel Grade was used to assess neurological function. The regional kyphosis angle was measured to evaluate the deformity correction. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were detected to assess the activity of tuberculosis. Bony fusion and complications were also recorded.

Results

The mean operation time was 204.4 ± 41.8 min. The mean estimated blood loss was 126.3 ± 94.4 ml. Preoperative Frankel Grade results indicated five patients with Grade C, six with Grade D, and five with Grade E. At the final follow-up, all patients were in Grade E. Twelve patients were brought back to normal spinal alignment and the rest four patients remained kyphotic. There was an improvement of 29.3° ± 18.3° in regional kyphotic angle postoperatively. And the deformity correction was 27.4° ± 19.1° at the final follow-up. ESR and CRP decreased to a normal range at three months follow-up. Bony fusion was achieved in all patients. None of the cases developed fixation failure, pseudoarthrosis, or tuberculosis recurrence.

Conclusion

Posterior fixation, combined with one- or two-stage anterior debridement and bone grafting, is a safe and effective surgical strategy for treating young children with thoracic and lumbar tuberculosis.

Bridwell KH, Lenke LG, McEnery KW, Baldus C, Blanke K (1995) Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine 20:1410–1418CrossRefPubMed

Cil A, Yazici M, Uzumcugil A, Kandemir U, Alanay A, Alanay Y, Acaroglu RE, Surat A (2005) The evolution of sagittal segmental alignment of the spine during childhood. Spine 30:93–100CrossRefPubMed

Deng J, Feng Y, Hu Y, Wei Y (2022) One-stage posterior vertebral column resection in the treatment of adolescent thoracic and lumbar tuberculosis complicated with severe kyphotic deformity. World Neurosurg 165:e22–e29. https://doi.org/10.1016/j.wneu.2022.04.039CrossRefPubMed

Egea-Gámez RM, Galán-Olleros M, González-Menocal A, Martínez-González C, González-Díaz R (2022) Surgical treatment for advanced thoracic spinal tuberculosis in infants: case series and literature review. Int J Spine Surg. https://doi.org/10.14444/8220CrossRefPubMedPubMedCentral

Garg B, Mehta N, Mukherjee RN, Swamy AM, Siamwala BS, Malik G (2022) Epidemiological insights from 1,652 patients with spinal tuberculosis managed at a single center: a retrospective review of 5-year data. Asian Spine J 16:162–172. https://doi.org/10.31616/asj.2021.0137CrossRefPubMed

Güven O, Kumano K, Yalçin S, Karahan M, Tsuji S (1994) A single stage posterior approach and rigid fixation for preventing kyphosis in the treatment of spinal tuberculosis. Spine 19:1039–1043. https://doi.org/10.1097/00007632-199405000-00007CrossRefPubMed

Huang QS, Zheng C, Hu Y, Yin X, Xu H, Zhang G, Wang Q (2009) One-stage surgical management for children with spinal tuberculosis by anterior decompression and posterior instrumentation. Int Orthop 33:1385–1390. https://doi.org/10.1007/s00264-009-0758-5CrossRefPubMedPubMedCentral

Jain AK, Rajasekaran S, Myneedu VP, Jaggi KR (2020) Tuberculosis of the Spine. J Bone Joint Surg Am 102:617–628. https://doi.org/10.2106/jbjs.19.00001CrossRefPubMed

Jain AK, Sreenivasan R, Mukunth R, Dhammi IK (2014) Tubercular spondylitis in children. Indian J Orthopa 48:136–144. https://doi.org/10.4103/0019-5413.128747CrossRef

10.

Jenkins HE, Yuen CM, Rodriguez CA, Nathavitharana RR, McLaughlin MM, Donald P, Marais BJ, Becerra MC (2017) Mortality in children diagnosed with tuberculosis: a systematic review and meta-analysis. Lancet Infect Dis 17:285–295. https://doi.org/10.1016/s1473-3099(16)30474-1CrossRefPubMed

11.

Khanna K, Sabharwal S (2019) Spinal tuberculosis: a comprehensive review for the modern spine surgeon. Spine J. https://doi.org/10.1016/j.spinee.2019.05.002CrossRefPubMed

12.

Lan T, Dong W, Fan J, Tang K, Qin S (2015) Spinal tuberculosis in children: a retrospective study of 112 cases. Chin J Spine Spinal Cord 25:195–201

13.

Li J, Lü GH, Wang B, Wang XB, Lu C, Kang YJ (2013) Pedicle screw implantation in the thoracic and lumbar spine of 1–4-year-old children: evaluating the safety and accuracy by a computer tomography follow-up. J Spinal Disord Tech 26:E46-52. https://doi.org/10.1097/BSD.0b013e31825d5c87CrossRefPubMed

14.

Maziad AM, Adogwa O, Duah HO, Yankey KP, Owusu DN, Sackeyfio A, Owiredu MA, Wilps T, Ofori-Amankwah G, Coleman F, Akoto H, Wulff I, Boachie-Adjei O (2021) Surgical management of complex post-tuberculous kyphosis among African patients: clinical and radiographic outcomes for a consecutive series treated at a single institution in West Africa. Spine Deform 9:777–788. https://doi.org/10.1007/s43390-020-00258-3CrossRefPubMed

15.

Mushkin AY, Naumov DG, Evseev VA (2018) Multilevel spinal reconstruction in pediatric patients under 4 years old with non-congenital pathology (10-year single-center cohort study). Eur Spine J 28:1035–1043. https://doi.org/10.1007/s00586-018-5756-0CrossRefPubMed

16.

Rajasekaran S (2001) The natural history of post-tubercular kyphosis in children. Radiological signs which predict late increase in deformity. J Bone Joint Surg Br 83:954–962. https://doi.org/10.1302/0301-620x.83b7.12170CrossRefPubMed

17.

Rajasekaran S (2007) Buckling collapse of the spine in childhood spinal tuberculosis. Clin Orthop Relat Res 460:86–92. https://doi.org/10.1097/BLO.0b013e31806a9172CrossRefPubMed

18.

Rajasekaran S, Soundarapandian S (1989) Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis. J Bone Joint Surg Am 71:1314–1323CrossRefPubMed

19.

Rathod TN, Shah KA (2020) Vertebral column resection for post tuberculosis severe kyphotic deformity: results of 5 year follow-up. J Orthop 19:122–127. https://doi.org/10.1016/j.jor.2019.11.036CrossRefPubMed

20.

Reuter A, Hughes J, Furin J (2019) Challenges and controversies in childhood tuberculosis. Lancet 394:967–978. https://doi.org/10.1016/s0140-6736(19)32045-8CrossRefPubMed

21.

Ruf M, Harms J (2002) Pedicle screws in 1- and 2-year-old children: technique, complications, and effect on further growth. Spine 27:E460-466. https://doi.org/10.1097/00007632-200211010-00019CrossRefPubMed

22.

Schulitz KP, Kothe R, Leong JC, Wehling P (1997) Growth changes of solidly fused kyphotic bloc after surgery for tuberculosis. Comparison of four procedures. Spine 22:1150–1155. https://doi.org/10.1097/00007632-199705150-00016CrossRefPubMed

23.

Suk SI, Kim JH, Kim WJ, Lee SM, Chung ER, Nah KH (2002) Posterior vertebral column resection for severe spinal deformities. Spine 27:2374–2382. https://doi.org/10.1097/00007632-200211010-00012CrossRefPubMed

24.

Wang Y, Zhang Y, Zhang X, Wang Z, Mao K, Chen C, Zheng G, Li G, Wood KB (2009) Posterior-only multilevel modified vertebral column resection for extremely severe Pott’s kyphotic deformity. Eur Spine J 18:1436–1441. https://doi.org/10.1007/s00586-009-1067-9CrossRefPubMedPubMedCentral

25.

Yin XH, Zhou ZH, Yu HG, Hu XK, Guo Q, Zhang HQ (2016) Comparison between the antero-posterior and posterior only approaches for treating thoracolumbar tuberculosis (T10–L2) with kyphosis in children: a minimum 3-year follow-up. Childs Nerv Syst 32:127–133. https://doi.org/10.1007/s00381-015-2935-8CrossRefPubMed

26.

Zhang H, Guo Q, Wang Y, Guo C, Tang M (2018) The efficiency of the posterior-only approach using shaped titanium mesh cage for the surgical treatment of spine tuberculosis in children: a preliminary study. J Orthop Surg 26:2309499018806684. https://doi.org/10.1177/2309499018806684CrossRef

Title: Posterior fixation, anterior debridement and bone grafting in the treatment of thoracic and lumbar tuberculosis in children younger than 3 years of age
Authors: Shutao Gao
Yakefu Abulizi
Fulati Mamat
Mardan Mamat
Weidong Liang
Hailong Guo
Chuanhui Xun
Weibin Sheng
Publication date: 01-12-2024
Publisher: Springer Vienna
Keywords: Tuberculosis
Tuberculosis
Wound Debridement
Published in: Acta Neurochirurgica / Issue 1/2024
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-024-05928-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Posterior fixation, anterior debridement and bone grafting in the treatment of thoracic and lumbar tuberculosis in children younger than 3 years of age

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

Microsurgical resection of a large petroclival meningioma through an extended retrosigmoid approach: how I do it

Tinnitus: an underreported condition following microvascular decompression for hemifacial spasm

Endovascular thrombectomy for treatment of isolated posterior cerebral artery occlusion: a real-world analysis of hospitalizations in the United States

Mechanical characteristics of glioblastoma and peritumoral tumor-free human brain tissue

Multiple surgical resections for progressive IDH wildtype glioblastoma—is it beneficial?

Anatomical damages in the spinal nerve roots and the spinal cord after brachial plexus injury: descriptive study from a cohort of consecutive patients who underwent DREZ-lesioning for pain—practical implications