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Posterior fixation, anterior debridement and bone grafting in the treatment of thoracic and lumbar tuberculosis in children younger than 3 years of age

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Abstract

Purpose

This study aimed to investigate the clinical outcomes of posterior fixation, combined with one- or two-stage anterior debridement and bone grafting in treating children younger than 3 years of age with thoracic and lumbar tuberculosis.

Methods

This was a retrospective study involving 16 young children with thoracic or lumbar tuberculosis. Surgical data were recorded. Frankel Grade was used to assess neurological function. The regional kyphosis angle was measured to evaluate the deformity correction. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were detected to assess the activity of tuberculosis. Bony fusion and complications were also recorded.

Results

The mean operation time was 204.4 ± 41.8 min. The mean estimated blood loss was 126.3 ± 94.4 ml. Preoperative Frankel Grade results indicated five patients with Grade C, six with Grade D, and five with Grade E. At the final follow-up, all patients were in Grade E. Twelve patients were brought back to normal spinal alignment and the rest four patients remained kyphotic. There was an improvement of 29.3° ± 18.3° in regional kyphotic angle postoperatively. And the deformity correction was 27.4° ± 19.1° at the final follow-up. ESR and CRP decreased to a normal range at three months follow-up. Bony fusion was achieved in all patients. None of the cases developed fixation failure, pseudoarthrosis, or tuberculosis recurrence.

Conclusion

Posterior fixation, combined with one- or two-stage anterior debridement and bone grafting, is a safe and effective surgical strategy for treating young children with thoracic and lumbar tuberculosis.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

ESR:

Erythrocyte sedimentation rate\

CRP:

C-reactive protein

T-SPOT:

T-cell spot test

CT:

Computed tomography

MRI:

Magnetic resonance imaging

References

  1. Bridwell KH, Lenke LG, McEnery KW, Baldus C, Blanke K (1995) Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine 20:1410–1418

    Article  PubMed  CAS  Google Scholar 

  2. Cil A, Yazici M, Uzumcugil A, Kandemir U, Alanay A, Alanay Y, Acaroglu RE, Surat A (2005) The evolution of sagittal segmental alignment of the spine during childhood. Spine 30:93–100

    Article  PubMed  Google Scholar 

  3. Deng J, Feng Y, Hu Y, Wei Y (2022) One-stage posterior vertebral column resection in the treatment of adolescent thoracic and lumbar tuberculosis complicated with severe kyphotic deformity. World Neurosurg 165:e22–e29. https://doi.org/10.1016/j.wneu.2022.04.039

    Article  PubMed  Google Scholar 

  4. Egea-Gámez RM, Galán-Olleros M, González-Menocal A, Martínez-González C, González-Díaz R (2022) Surgical treatment for advanced thoracic spinal tuberculosis in infants: case series and literature review. Int J Spine Surg. https://doi.org/10.14444/8220

    Article  PubMed  PubMed Central  Google Scholar 

  5. Garg B, Mehta N, Mukherjee RN, Swamy AM, Siamwala BS, Malik G (2022) Epidemiological insights from 1,652 patients with spinal tuberculosis managed at a single center: a retrospective review of 5-year data. Asian Spine J 16:162–172. https://doi.org/10.31616/asj.2021.0137

    Article  PubMed  Google Scholar 

  6. Güven O, Kumano K, Yalçin S, Karahan M, Tsuji S (1994) A single stage posterior approach and rigid fixation for preventing kyphosis in the treatment of spinal tuberculosis. Spine 19:1039–1043. https://doi.org/10.1097/00007632-199405000-00007

    Article  PubMed  Google Scholar 

  7. Huang QS, Zheng C, Hu Y, Yin X, Xu H, Zhang G, Wang Q (2009) One-stage surgical management for children with spinal tuberculosis by anterior decompression and posterior instrumentation. Int Orthop 33:1385–1390. https://doi.org/10.1007/s00264-009-0758-5

    Article  PubMed  PubMed Central  Google Scholar 

  8. Jain AK, Rajasekaran S, Myneedu VP, Jaggi KR (2020) Tuberculosis of the Spine. J Bone Joint Surg Am 102:617–628. https://doi.org/10.2106/jbjs.19.00001

    Article  PubMed  Google Scholar 

  9. Jain AK, Sreenivasan R, Mukunth R, Dhammi IK (2014) Tubercular spondylitis in children. Indian J Orthopa 48:136–144. https://doi.org/10.4103/0019-5413.128747

    Article  Google Scholar 

  10. Jenkins HE, Yuen CM, Rodriguez CA, Nathavitharana RR, McLaughlin MM, Donald P, Marais BJ, Becerra MC (2017) Mortality in children diagnosed with tuberculosis: a systematic review and meta-analysis. Lancet Infect Dis 17:285–295. https://doi.org/10.1016/s1473-3099(16)30474-1

    Article  PubMed  Google Scholar 

  11. Khanna K, Sabharwal S (2019) Spinal tuberculosis: a comprehensive review for the modern spine surgeon. Spine J. https://doi.org/10.1016/j.spinee.2019.05.002

    Article  PubMed  Google Scholar 

  12. Lan T, Dong W, Fan J, Tang K, Qin S (2015) Spinal tuberculosis in children: a retrospective study of 112 cases. Chin J Spine Spinal Cord 25:195–201

    Google Scholar 

  13. Li J, Lü GH, Wang B, Wang XB, Lu C, Kang YJ (2013) Pedicle screw implantation in the thoracic and lumbar spine of 1–4-year-old children: evaluating the safety and accuracy by a computer tomography follow-up. J Spinal Disord Tech 26:E46-52. https://doi.org/10.1097/BSD.0b013e31825d5c87

    Article  PubMed  Google Scholar 

  14. Maziad AM, Adogwa O, Duah HO, Yankey KP, Owusu DN, Sackeyfio A, Owiredu MA, Wilps T, Ofori-Amankwah G, Coleman F, Akoto H, Wulff I, Boachie-Adjei O (2021) Surgical management of complex post-tuberculous kyphosis among African patients: clinical and radiographic outcomes for a consecutive series treated at a single institution in West Africa. Spine Deform 9:777–788. https://doi.org/10.1007/s43390-020-00258-3

    Article  PubMed  Google Scholar 

  15. Mushkin AY, Naumov DG, Evseev VA (2018) Multilevel spinal reconstruction in pediatric patients under 4 years old with non-congenital pathology (10-year single-center cohort study). Eur Spine J 28:1035–1043. https://doi.org/10.1007/s00586-018-5756-0

    Article  PubMed  Google Scholar 

  16. Rajasekaran S (2001) The natural history of post-tubercular kyphosis in children. Radiological signs which predict late increase in deformity. J Bone Joint Surg Br 83:954–962. https://doi.org/10.1302/0301-620x.83b7.12170

    Article  PubMed  CAS  Google Scholar 

  17. Rajasekaran S (2007) Buckling collapse of the spine in childhood spinal tuberculosis. Clin Orthop Relat Res 460:86–92. https://doi.org/10.1097/BLO.0b013e31806a9172

    Article  PubMed  CAS  Google Scholar 

  18. Rajasekaran S, Soundarapandian S (1989) Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis. J Bone Joint Surg Am 71:1314–1323

    Article  PubMed  CAS  Google Scholar 

  19. Rathod TN, Shah KA (2020) Vertebral column resection for post tuberculosis severe kyphotic deformity: results of 5 year follow-up. J Orthop 19:122–127. https://doi.org/10.1016/j.jor.2019.11.036

    Article  PubMed  Google Scholar 

  20. Reuter A, Hughes J, Furin J (2019) Challenges and controversies in childhood tuberculosis. Lancet 394:967–978. https://doi.org/10.1016/s0140-6736(19)32045-8

    Article  PubMed  Google Scholar 

  21. Ruf M, Harms J (2002) Pedicle screws in 1- and 2-year-old children: technique, complications, and effect on further growth. Spine 27:E460-466. https://doi.org/10.1097/00007632-200211010-00019

    Article  PubMed  Google Scholar 

  22. Schulitz KP, Kothe R, Leong JC, Wehling P (1997) Growth changes of solidly fused kyphotic bloc after surgery for tuberculosis. Comparison of four procedures. Spine 22:1150–1155. https://doi.org/10.1097/00007632-199705150-00016

    Article  PubMed  CAS  Google Scholar 

  23. Suk SI, Kim JH, Kim WJ, Lee SM, Chung ER, Nah KH (2002) Posterior vertebral column resection for severe spinal deformities. Spine 27:2374–2382. https://doi.org/10.1097/00007632-200211010-00012

    Article  PubMed  Google Scholar 

  24. Wang Y, Zhang Y, Zhang X, Wang Z, Mao K, Chen C, Zheng G, Li G, Wood KB (2009) Posterior-only multilevel modified vertebral column resection for extremely severe Pott’s kyphotic deformity. Eur Spine J 18:1436–1441. https://doi.org/10.1007/s00586-009-1067-9

    Article  PubMed  PubMed Central  Google Scholar 

  25. Yin XH, Zhou ZH, Yu HG, Hu XK, Guo Q, Zhang HQ (2016) Comparison between the antero-posterior and posterior only approaches for treating thoracolumbar tuberculosis (T10–L2) with kyphosis in children: a minimum 3-year follow-up. Childs Nerv Syst 32:127–133. https://doi.org/10.1007/s00381-015-2935-8

    Article  PubMed  Google Scholar 

  26. Zhang H, Guo Q, Wang Y, Guo C, Tang M (2018) The efficiency of the posterior-only approach using shaped titanium mesh cage for the surgical treatment of spine tuberculosis in children: a preliminary study. J Orthop Surg 26:2309499018806684. https://doi.org/10.1177/2309499018806684

    Article  Google Scholar 

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Author notes

  1. Shutao Gao and Yakefu Abulizi contributed equally to this work.

Authors and Affiliations

  1. Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China

    Shutao Gao, Yakefu Abulizi, Fulati Mamat, Mardan Mamat, Weidong Liang, Hailong Guo, Chuanhui Xun & Weibin Sheng

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  1. Shutao Gao
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Contributions

WS contributed to the study conception and design. SG, YA, FM, MM, WL, HG performed material preparation, data collection and data analysis. SG and YA drafted the manuscript. FM and CX revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Weibin Sheng.

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The study was approved by the ethics committee of our hospital.

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The authors declared no competing interests.

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Gao, S., Abulizi, Y., Mamat, F. et al. Posterior fixation, anterior debridement and bone grafting in the treatment of thoracic and lumbar tuberculosis in children younger than 3 years of age. Acta Neurochir 166, 25 (2024). https://doi.org/10.1007/s00701-024-05928-z

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