title: Surgical treatment of thoracic Pott disease in a 3-year-old child, with vertebral column resection and posterior-only circumferential reconstruction of the spinal column: case report.
abstract: Tuberculosis (TB) is a common disease worldwide that is caused by Mycobacterium tuberculosis. Tuberculosis of the spine, also called Pott disease, is the most common site of bony dissemination. Although children are disproportionately affected, spinal TB is nonetheless rare in very young children. Cases involving infants requiring surgical intervention have been previously reported, and they are often associated with greater management challenges given the technical difficulty with instrumentation in very young children.   This case involved a 3-year-old girl with TB centered at T-6, who presented with myelopathy from spinal cord compression and a severe kyphotic deformity (> 60°). She underwent a single-stage costotransversectomy for vertebral column resection, followed by reconstruction with an anterior expandable titanium cage and posterior pedicle screw instrumentation. At last follow-up, the patient was clinically and radiographically stable.   The authors report on the youngest patient with spinal TB treated surgically with this strategy and review the literature regarding prior cases involving young children. Although limited by the paucity of cases in the literature, surgical debridement and spinal fusion appear to provide a safe alternative to prolonged bed rest or casting and may offer additional benefits of a faster recovery and ambulation.
authors.affiliation: Department of Neurosurgery, Division of Pediatric Neurosurgery, Neuro-spine Program, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Rangel-Castilla
authors.forename: Steven W
authors.initials: SW
authors.lastname: Hwang
authors.forename: William E
authors.initials: WE
authors.lastname: Whitehead
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Curry
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Luerssen
authors.forename: Andrew
authors.initials: A
authors.lastname: Jea
mesh_terms: D001416:Back Pain / Q000382:microbiology; D002675:Child, Preschool; D005260:Female; D005684:Gait; D006801:Humans; D007738:Kyphosis / Q000382:microbiology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D019651:Plastic Surgery Procedures / Q000295:instrumentation; D013131:Spine / Q000382:microbiology / Q000601:surgery*; D013166:Spondylitis / Q000382:microbiology; D013904:Thoracic Vertebrae / Q000382:microbiology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*