title: One-year multidrug treatment for tuberculosis of the cervical spine in children.
abstract: OBJECTIVE
  To review the clinical and radiological features and treatment outcome in 22 children who underwent one-year antitubercular multidrug treatment for tuberculosis of the cervical spine.
  
  
  METHODS
  Records of 13 boys and 9 girls aged 2 to 12 (mean, 9.1) years who underwent one-year antitubercular multidrug treatment for tuberculosis of the cervical spine were reviewed. Tuberculosis involved the atlantoaxial region (C1-C2) in 7 patients, mid-cervical region (C3-C7) in 8, cervicodorsal region (C6-T3) in 3, contiguous multilevels in 2, and non-contiguous multifocal areas in 2. The mean number of vertebrae involved was 2.8 (range, 1-8). The mean symptom duration was 2.5 (range, 0.25-6) months. Three patients had neurological deficits. Antitubercular multidrug treatment included an intensive phase for 2 months and a continuation phase for 10 months, using isoniazid, rifampicin, pyrazinamide, and ethambutol.
  
  
  RESULTS
  At a mean of 2.25 (range, 0.5-5) years after treatment, no patient had recurrence, pain, or dynamic instability. Full range of movement was achieved after a mean of 2.7 (range, 1-4) months in all but 3 patients. In the 3 patients with neurological deficits, recovery was achieved after a mean of 8 (range, 5-14) weeks. Soft tissue swelling resolved after a mean of 11 (range, 8-12) weeks. Remineralisation of vertebrae occurred after a mean of 2 (range, 2-6) months. Spontaneous vertebral fusion occurred in only 6 of 22 patients after a mean of 36 (range, 18-72) months. Three patients developed kyphotic deformity.
  
  
  CONCLUSIONS
  Antitubercular multidrug treatment is a viable option for children with tuberculosis of the cervical spine, even in the presence of neurological deficits. Development of deformity is not common; interbody fusion is usually delayed. Patients with contiguous multilevel involvement with vertebral erosion or collapse should be closely monitored for development of late deformity.
authors: Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalya, Geeta Colony, Delhi, India.
authors: Anil
authors: A
authors: Agarwal
authors: Kumar Shashi
authors: KS
authors: Kant
authors: Anubrat
authors: A
authors: Kumar
authors: Abbas
authors: A
authors: Shaharyar
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use*; D002574:Cervical Vertebrae; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D013123:Spinal Fusion / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000628:therapy*
chemical_list: D000995:Antitubercular Agents
keywords: bantitubercular agents; child; tuberculosis, spinal