“Surgical management of spinal tuberculosis in children, our experience”

Volume 6 | Issue 1 | Jan-April 2018 | Page 28-34 | Srinivasalu S, Madan Mohan M, Anoop P, Thomas Issac, Mallikarjunaswamy B


Authors: Srinivasalu S [1], Madan Mohan M [1], Anoop P [1], Thomas Issac [1], Mallikarjunaswamy B [1].

[1]Department of Orthopaedics, St. John’s Medical College Hospital, Sarjapur Road, Bangalore 560034

Address of Correspondence
Dr. Madan Mohan M
Department of Orthopaedics, St. John’s Medical College Hospital,
Sarjapur Road, Bangalore 560 034
Email : drmadanmmohan@yahoo.co.in


Abstract

Study Design: Retrospective Descriptive study
Purpose: The goal of this study was to assess the outcome of surgical management of 10 pediatric Pott’s spine cases.
Overview of Literature: Spinal tuberculosis represents 50% of skeletal tuberculosis cases and 0.5-1% of all cases. Children are affected in 5-15% of cases. Antituberculous chemotherapy remains the mainstay of treatment of the tubercular spine with very good response in paediatric patients. However, children are more prone to kyphotic deformity of the spine.
Methods: All cases were followed-up for an average of 23.1 months (range 14–48 months). Ages ranged from 7 to 17 years. There were 8 male and 2 female children. All patients were treated with antituberculous chemotherapy which was continued after the surgical intervention also. The anatomical distribution was: Fifty per cent thoracic, 30% thoracolumbar, and 20% lumbar. Indications for surgery included: deformity (60%), neurological compromise (30%), and pain (10%). The majority of the fusions were anterior (7) the others were posterior (3).
Results: All patients were relieved of pain post operatively (evaluated by VAS, visual analog scale). Only 3 patients had neurological deficits, all of them improved post operatively (evaluated by Frankel classification grading system). The kyphotic angle improved from an average of 27.5° to 11.7° in the immediate post-operative period. Average kyphotic angle in the final follow up was 13.7° with an average 2° loss of correction.
Conclusions: Even though spinal tuberculosis is a curable medical condition, surgery in carefully selected patients by either anterior or posterior approach with instrumentation is a feasible and effective way of achieving and maintaining good correction of deformity and disease control.
Keywords : Pediatric spine; Tuberculous spondylitis; Surgical Management


References

1. Lönnroth K, Raviglione M. Global epidemiology of tuberculosis: prospects for control. Semin Respir Crit Care Med. 2008; 29:481–491.
2. Rasouli MR, Mirkoohi M, Vaccaro AR, Yarandi KK, Rahimi-Movaghar V. Spinal Tuberculosis: Diagnosis and Management. Asian Spine J.2012;6(4):294-308.
3. Huang Q-S, Zheng C, Hu Y, et al. One-stage surgical management for children with spinal tuberculosis by anterior decompression and posterior instrumentation. International Orthopaedics. 2009;33(5):1385-1390.
4. Kumar R, Srivastava AK, Tiwari RK. Surgical management of Pott’s disease of the spine in pediatric patients: A single surgeon’s experience of 8 years in a tertiary care center. J Pediatr Neurosci. 2011;6(Suppl1): S101-S108.
5. Jain AK, Sreenivasan R, Mukunth R, Dhammi IK. Tubercular spondylitis in children. Indian J Orthop. 2014;48(2):136-144.
6. Frankel HL, Hancock DO, Hyslop G, et al. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Paraplegia. 1969; 7:179–192.
7. Rajasekaran S, Shanmugasundaram TK (1987) Prediction of the angle of gibbus deformity in tuberculosis of the spine, J Bone Joint Surg [Am] 69:503–508
8. Garg RK, Somvanshi DS. Spinal tuberculosis: A review. J Spinal Cord Med. 2011;34(5):440-454.
9. Jain AK. Tuberculosis of the spine. Clin Orthop Relat Res. 2007; 460:2–3.
10. Moon MS, Moon YW, Moon JL, et al. Conservative treatment of tuberculosis of the lumbar and lumbosacral spine. Clin Orthop Relat Res. 2002; 398:40–49.
11. Jutte PC, Van Loenhout-Rooyackers JH. Routine surgery in addition to chemotherapy for treating spinal tuberculosis. Cochrane Database Syst Rev 2006
12. Jain AK, Kumar J. Tuberculosis of spine: neurological deficit. Eur Spine J. 2013;22(Suppl 4):624-633.
13. Jain AK. Tuberculosis of the spine: a fresh look at an old disease. J Bone Joint Surg Br. 2010; 92:905–913.
14. Sai Kiran NA, Vaishya S, Kale SS. Surgical results in patients with tuberculosis of the spine and severe lower-extremity motor deficits: a retrospective study of 48 patients. J Neurosurg Spine 2007; 6: 320–326.
15. Dalal S, Modi J, Soman S, Patel H, Dhanani S. Results of Single-Staged Posterior Decompression and Circumferential Fusion Using a Transpedicular Approach to Correct a Kyphotic Deformity due to Thoracolumbar Spinal Tuberculosis. Asian Spine J. 2016;10(6):1106-1114.
16. Moon MS. Tuberculosis of the spine. Controversies and a new challenge. Spine. 1997; 22:1791–1797.
17. Ferrer MF, Torres LG, Ramírez OA, Zarzuelo MR, Del Prado González N. Tuberculosis of the spine. A systematic review of case series. Int Orthop. 2012 Feb;36(2):221-31.
18. Guerado E, Cer ván AM. Surgical treatment of spondylodiscitis. An update. Int Orthop. 2012;36(2):413–20.
19. Wang X, Li J, Lu G, Wang B, Lu C, Kang Y. Singlestage posterior instrumentation and anterior debridement for active tuberculosis of the thoracic and lumbar spine with kyphotic deformity. Int Orthop. 2012;36(2):373–80.
20. Ma YZ, Cui X, li HW, Chen X, Cai XJ, Bai YB. Outcomes of anterior and posterior instrumentation under different surgical procedures for treating thoracic and lumbar spinal tuberculosis in adults. Int Orthop. 2012;36(2):299–305.
21. Moon M-S, Kim S-S, Lee B-J, Moon J-L. Spinal tuberculosis in children: Retrospective analysis of 124 patients. Indian J Orthop. 2012;46(2):150-158.
22. Sun L, Song Y, Liu L, Gong Q, Zhou C. One-stage posterior surgical treatment for lumbosacral tuberculosis with major vertebral body loss and kyphosis. Orthopedics. 2013;36: e1082–90.
23. Jain AK. Treatment of tuberculosis of the spine with neurologic complications. Clin Orthop Relat Res. 2002; 398:75–84.
24. Reid C, Dunn RN. The surgical management of spinal tuberculosis in children and adolescents. SA Orthop. J. 2009; 8(4): 56-62.
25. Chen WJ, Chen CH, Shih CH. Surgical treatment of tuberculous spondylitis: 50 patients followed for 2-8 years, Acta Orthop Scand. 1995; 66:2, 137-142.
26. Mushkin AY, Kovalenko KN. Neurological complications of spinal tuberculosis in children. Int Orthop. 1999; 23:210–2.
27. Rajasekaran S. The natural history of post-tubercular kyphosis in children. J Bone Joint Surg Br. 2001; 83:954–962.
28. Rajasekaran S. The problem of deformity in spinal tuberculosis. Clin Orthop Relat Res. 2002; 398:85–92.
29. Jain AK, Aggarwal PK, Arora A, et al. Behaviour of the kyphotic angle in spinal tuberculosis. Int Orthop. 2004; 28:110–114.
30. Upadhyay SS, Saji MJ, Sell B, Hsu LC. Spinal deformity after childhood surgery for tuberculosis of the spine: A comparison of radical surgery and debridement. J Bone Joint Surg. 1994; 76:91–8.
31. Upadhyay SS, Sell P, Saji MJ, Sell B, Yau AC, Leong JCY. 17-year prospective study of surgical management of spinal tuberculosis in children.Hong Kong operation compared with debridement surgery for short-and long-term outcome of deformity. Spine (Phila Pa 1976) 1993; 18:1704–11.
32. Rajasekaran S. The natural history of post-tubercular kyphosis in children. Radiological signs which predict late increase in deformity. J Bone Joint Surg Br. 2001; 83:954–962.
33. Tuli SM (1995) Severe kyphotic deformity in tuberculosis of the spine. Int Orthop 19(5):327–331.
34. Issack PS, Boachie-Adjei O. Surgical correction of kyphotic deformity in spinal tuberculosis. Int Orthop. 2012;36(2):353-357.
35. Yau ACMC, Hsu LCS, O’Brien JP, Hodgson AR. Tuberculosis kyphosis-correction with spinal osteotomy, halo-pelvic distraction and anterior and posterior fusion. J Bone Joint Surg. 1974;56A:1419–1434.
36. Rajasekaran S, Soundarapandian S. Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis. J Bone Joint Surg [Am] 1989;71-A:1314-23.
37. Pu X, Zhou Q, He Q, et al. A posterior versus anterior surgical approach in combination with debridement, interbody autografting and instrumentation for thoracic and lumbar tuberculosis. Int Orthop. 2012;36(2):307-313
38. Zhang HQ, Wang YX, Guo CF, et al. One-stage posterior approach and combined interbody and posterior fusion for thoracolumbar spinal tuberculosis with kyphosis in children. Orthopedics. 2010; 33:808.


How to Cite this article: Srinivasalu S, Madan M M, Anoop P, Issac T, Mallikarjunaswamy B. Surgical Management of Spinal Tuberculosis in Children, our Experience. J Kar Orth Assoc. Jan-April 2018; 6(1): 28-34

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