One-stage posterior approach and combined interbody and posterior fusion for thoracolumbar spinal tuberculosis with kyphosis in children.
The goal of this study was to determine the efficacy and feasibility of surgical management of advanced thoracolumbar spine tuberculosis with kyphosis in children in poor general condition with 1-stage posterior decompression, interbody grafts, and posterior instrumentation and fusion. Between 2006 and 2008, 7 children with advanced thoracolumbar spinal tuberculosis accompanied by kyphosis and in poor general condition were treated with 1-stage posterior decompression, interbody grafts, and posterior instrumentation and fusion followed by chemotherapy. Mean follow-up was 34 months (range, 27-42 months). Patients were evaluated pre- and postoperatively for erythrocyte sedimentation rate (ESR), neurological status, pain, spinal canal compromise, and kyphotic angle. Spinal tuberculosis was completely cured and the grafted bones fused in all 7 patients. There was no recurrence of the disease in any patient at final follow-up. In all patients, ESR was normal within 3 months, Frankel neurological classification improved, and pain relief was obtained. Average canal compromise was 52.57% (range, 35%-75%) preoperatively and 9.86% (range, 0%-19%) postoperatively. Average preoperative kyphosis was 37.9°, which decreased to 5.4° postoperatively. There was no significant loss of correction at last follow-up. Our results show that 1-stage posterior decompression, interbody grafts, and posterior instrumentation and fusion followed by chemotherapy is an alternative treatment for children with advanced thoracolumbar spinal tuberculosis and in poor general condition.
Department of Spine Surgery, Xiangya Spinal Surgery Center, Xiangya Hospital of Central South University, ChangSha, China.
Hong-Qi
HQ
Zhang
Yu-Xiang
YX
Wang
Chao-Feng
CF
Guo
Jin-Yang
JY
Liu
Jian-Huang
JH
Wu
Jing
J
Chen
Dai
D
Guo
Ming-Xing
MX
Tang
D000995:Antitubercular Agents / Q000627:therapeutic use; D016025:Bone Transplantation; D002648:Child; D003131:Combined Modality Therapy; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D016348:Osseointegration; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D016896:Treatment Outcome; D014394:Tuberculosis, Osteoarticular / Q000150:complications / Q000473:pathology / Q000628:therapy*
D000995:Antitubercular Agents