Summary: Various surgeries have been applied to treat children spinal tuberculosis.Anterior and combined anterior and posterior surgery have been recommended by most surgeons. However,as the treatment strategy has become more conservative in recent years, some surgeons have performed one‐stage posterior surgery for the treatment of adult spinal tuberculosis during these years and have proved that it is an effective method in the treatment of spinal tuberculosis. Surgical management of advanced children thoracolumbar spine tuberculosis with kyphosis and in poor general condition by using this method in one center is not reported in the peer‐reviewed literature nowadays.
Introduction: 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.
Methods: Between 2006 to 2008,seven children with advanced thoracolumbar spinal tuberculosis accompanied by kyphosis and in poor general condition were treated with one‐stage posterior decompression, interbody grafts and posterior instrumentation and fusion followed by chemotherapy. The chemotherapy persisted for at least 12 months in all patients. The mean follow‐up was 34 months (range27‐42 months).Patients were evaluated before and after surgery in terms of ESR,neurological status,pain,spinal canal compromise,kyphotic angle.
Results: Spinal tuberculosis was completely cured and the grafted bones were fused in all 7 patients. There was no recurrence and persistence of the disease in any of the patients at the final follow‐up. ESR got normal within 3 months in all patients. The Frankel neurological classification improved in all cases. Pain relief was obtained in all patients. The average canal compromise was 52.57% (range, 35‐75%) before surgery and 9.86% (range, 0‐19%) after surgery. The average preoperative kyphosis was 37.9°and decreased to 5.4°postoperatively.There was no significant loss of the correction at the latest follow‐up.
Conclusion: Although we do not underestimate the usefulness of anterior surgery in spinal tuberculosis,our results show that one‐stage posterior decompression, interbody grafts, and posterior instrumentation and fusion followed by chemotherapy was an alternative treatment for children with advanced thoracolumbar spinal tuberculosis and in poor general condition. lt is characterized as minimum surgical intervention,encouraging neurological recovery,good correction of kyphosis and prevention of progressive kyphosis.