title: Two-stage surgical management using posterior instrumentation, anterior debridement and allografting for tuberculosis of the lower lumbar spine in children of elementary school age: minimum 3-year follow-up of 14 patients.
abstract: OBJECTIVE
  Various surgical methods have been described for the management of lumbar tuberculous spondylitis in the literature. However, there were few reports on the two-stage surgical treatment of lumbar tuberculosis in children of elementary school age. We present a retrospective clinical study of 14 patients with lumbar and lumbosacral tuberculous spondylitis treated by two-stage surgery (first stage: posterior instrumentation; second stage: anterior debridement and allografting). The purpose is to determine the clinical efficacy of such surgical treatment for lumbar tuberculosis in children.
  
  
  METHODS
  Our series was comprised 9 males and 5 females with an average age of 7.5 years treated with the above-mentioned surgical procedure. All patients had lumbar and lumbosacral involvement with one patient having spondylitis at L2-3, three at L3-4, seven at L4-5, and three at L5-S1. All patients had single motion segment involvement. The Frankel scoring system was used to assess the neurological deficits. Frankel's grade B in two patients, grade C in four and grade D in eight. The following data were followed-up for an average period of 50.1 months (42-64 months) in these patients: healing of disease, deformity correction and its maintenance, neurologic function, and spinal bony fusion.
  
  
  RESULTS
  The average preoperative local deformity angle was -13.8°, correcting to 3.4° postoperatively and 1.5° at the final follow-up. With the exception of one patient who received a D at the final follow-up, all cases obtained complete neurological recovery. No breakage and looseness of internal fixation was found. Bony fusion was achieved in all cases within 6 months postoperatively. There was no recurrent tuberculous infection.
  
  
  CONCLUSIONS
  Two-stage (posterior and anterior) surgery is a safe and effective procedure for the patient of elementary school age suffering from lumbar and lumbosacral tuberculous spondylitis, especially for the patients in poor general condition. The procedure has the advantage of minor surgical invasion, effective kyphosis correction and less complications.
authors.affiliation: Department of Spine Surgery, Xiangya Hospital of Central South University, Xiangya Road 87, Changsha, China. zhq9996@163.com
authors.forename: Hong Qi
authors.initials: HQ
authors.lastname: Zhang
authors.forename: Jin Song
authors.initials: JS
authors.lastname: Li
authors.forename: Chao Feng
authors.initials: CF
authors.lastname: Guo
authors.forename: Shao Hua
authors.initials: SH
authors.lastname: Liu
authors.forename: Ming Xing
authors.initials: MX
authors.lastname: Tang
authors.forename: Yu Xiang
authors.initials: YX
authors.lastname: Wang
authors.forename: Ang
authors.initials: A
authors.lastname: Deng
authors.forename: Qi
authors.initials: Q
authors.lastname: Le Gao
authors.forename: Min Zhong
authors.initials: MZ
authors.lastname: Lin
mesh_terms: D016025:Bone Transplantation; D002648:Child; D002675:Child, Preschool; D003646:Debridement; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae; D008297:Male; D012189:Retrospective Studies; D012447:Sacrum; D013123:Spinal Fusion / Q000295:instrumentation; D014184:Transplantation, Homologous; D014399:Tuberculosis, Spinal / Q000601:surgery*