Child's Nervous System

, Volume 27, Issue 5, pp 735–742 | Cite as

One-stage posterior focus debridement, fusion, and instrumentation in the surgical treatment of cervicothoracic spinal tuberculosis with kyphosis in children: a preliminary report

  • Hong-Qi Zhang
  • Yu-Xiang Wang
  • Chao-feng Guo
  • Di Zhao
  • Ang Deng
  • Jian-Huang Wu
  • Jin-Yang Liu
Original Paper



To determine the efficacy and feasibility of surgical management of cervicothoracic tuberculosis accompanied by kyphosis in children by using one-stage posterior focus debridement, bone graft fusion, and instrumentation at a single institution.


Ten consecutive cases with cervicothoracic tuberculosis with kyphosis were treated with one-stage posterior focus debridement, bone graft fusion, and instrumentation. The mean follow-up was 36 months (range26–47 months). The kyphotic angle ranged from 35° to 62° before operation, 50.5° in average. The American Spinal Injury Association score system was used to evaluate the neurological deficits.


Spinal tuberculosis was completely cured in all ten patients. There was no recurrent tuberculous infection. The postoperative kyphotic angle was 10° to 22°, 17.5° in average, and there was no significant loss of the correction at the latest follow-up. Solid fusion was achieved in all cases. Neurological condition in all patients was improved after surgery.


One-stage posterior debridement, bone grafting, and instrumentation can be an effective treatment method of cervicothoracic spinal tuberculosis with kyphosis in children.


Children Cervicothoracic Spinal tuberculosis Posterior 


  1. 1.
    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-B:954–962CrossRefGoogle Scholar
  2. 2.
    Govender S, Parbhoo AH, Kumar KP (2001) Tuberculosis of the cervicodorsal junction. J Pediatr Orthop 21:285–287PubMedCrossRefGoogle Scholar
  3. 3.
    Govender S, Ramnarain A, Danaviah S (2007) Cervical spine tuberculosis in children. Clin Orthop Relat Res 460:78–85PubMedCrossRefGoogle Scholar
  4. 4.
    Dituno J (1996) Rehabilitation assessment and management in the acute spinal cord injury (SCI) patient. In: Narayan RK, Wilberger JE, Povlishock JT (eds) Neurotrauma. McGraw-Hill, New York, pp 1259–1266Google Scholar
  5. 5.
    Rajasekaran S (2007) Buckling collapse of the spine in childhood spinal tuberculosis. Clin Orthop Relat Res 460:86–92PubMedGoogle Scholar
  6. 6.
    Jain AK (2007) Tuberculosis of the spine. Clin Orthop Relat Res 460:39–49PubMedCrossRefGoogle Scholar
  7. 7.
    Tuli SM (2007) Tuberculosis of the spine: a historical review. Clin Orthop Relat Res 460:29–38PubMedGoogle Scholar
  8. 8.
    Prabhakar MM, Thakker T (2006) Anterior decompression for cervicothoracic pathology: a study of 14 patients. J Spinal Cord Med 29:163–166PubMedGoogle Scholar
  9. 9.
    Pointillart V, Aurouer N, Gangnet N et al (2007) Anterior approach to the cervicothoracic junction without sternotomy: a report of 37 cases. Spine 32:2875–2879PubMedCrossRefGoogle Scholar
  10. 10.
    Schulitz KP, Kothe R, Leong JC et al (1997) Growth changes of solidly fused kyphotic bloc after surgery for tuberculosis: comparison of four procedures. Spine 22:1150–1155PubMedCrossRefGoogle Scholar
  11. 11.
    Rajasekaran S, Soundarapandian S (1989) Progression of kyphosis in tuberculosis of the spine treated by anterior arthodesis. J Bone Joint Surg Am 71:1314–1323PubMedGoogle Scholar
  12. 12.
    Fountain SS, Hsu LCS, Yau ACMC et al (1975) Progressive kyphosis following solid anterior spine fusion in children with tuberculosis of the spine. J Bone Joint Surg Am 57:1104–1107PubMedGoogle Scholar
  13. 13.
    Sundararaj GD, Behera S, Ravietal V (2003) Role of posterior stabilization in the management of tuberculosis of the dorsal and lumbar spine. J Bone Joint Surg Br 85-B:100–106CrossRefGoogle Scholar
  14. 14.
    UfukTalu AG, Ozturk C et al (2006) The role of posterior instrumentation and fusion after anterior radical debridement and fusion in the surgical treatment of spinal tuberculosis: experience of 127 cases. J Spinal Disord Tech 19:554–559CrossRefGoogle Scholar
  15. 15.
    Kumar K (1992) The penetration of drugs into the lesions of spinal tuberculosis. Int Orthop 16:67–68PubMedGoogle Scholar
  16. 16.
    Feyza KG, Erhan EN, Serdar B et al (2005) Thoracic and lumbar tuberculous spondylitis treated by posterior debridement, graft placement, and instrumentation: a retrospective analysis in 19 cases. J Neurosurg Spine 3:450–458CrossRefGoogle Scholar
  17. 17.
    Rath SA, Neff U, Schneider O, Richter HP (1996) Neurosurgical management of thoracic and lumbar vertebral osteomyelitis and discitis in adults: a review of 43 consecutive surgically treated patients. Neurosurgery 38:926–933PubMedCrossRefGoogle Scholar
  18. 18.
    Mehta JS, Bhojraj SY (2001) Tuberculosis of the thoracic spine. A classification based on the selection of the surgical strategies. J Bone Joint Surg Br 83:859–863PubMedCrossRefGoogle Scholar
  19. 19.
    Chen YC, Chang MC, Wang ST et al (2003) One-stage posterior surgery for treatment if advanced spinal tuberculosis. J Chin Med Assoc 66:411–417PubMedGoogle Scholar
  20. 20.
    Christian Mazel, Hoffmann E, Antonietti P et al (2004) Posterior cervicothoracic instrumentation in spine tumors. Spine 29:1246–1253CrossRefGoogle Scholar
  21. 21.
    Lee Sun-Ho, Sung J-K, Park Y-M (2006) Single-stage transpedicular decompression and posterior instrumentation in treatment of thoracic and thoracolumbar spinal tuberculosis. A retrospective case series. J Spinal Disord Tech 19:595–602PubMedCrossRefGoogle Scholar
  22. 22.
    Rajasekaran S, Prasad SA, Dheenadhayalan J et al (2006) Morphological changes during growth in healed childhood spinal tuberculosis: a 15-year prospective study of 61 children treated with ambulatory chemotherapy. J Pediatr Orthop 26:716–724PubMedCrossRefGoogle Scholar
  23. 23.
    DadiJin Dongbin Qu, Chen J et al (2004) One-stage anterior interbody autografting and instrumentation in primary surgical management of thoracolumbar spinal tuberculosis. Eur Spine J 13:114–121CrossRefGoogle Scholar
  24. 24.
    Roach JW, Ashman RB, Allard RN (1990) The strength of a posterior element claw at one versus two spinal levels. J Spinal Disord 3:259–261PubMedCrossRefGoogle Scholar
  25. 25.
    Fagerström T, Hedlund R, Bancel P et al (2001) Laminar hook instrumentation in the cervical spine. An experimental study on the relation of hooks to the spinal cord. Eur Spine J 10:340–344PubMedCrossRefGoogle Scholar
  26. 26.
    Vara CS, Thompson GH (2006) A cadaveric examination of pediatric cervical pedicle morphology. Spine 31:1107–1112PubMedCrossRefGoogle Scholar
  27. 27.
    Ruf M, Harms J (2002) Pedicle screws in 1- and 2-year-old children: technique, complications, and effect on further growth. Spine 27:460–466CrossRefGoogle Scholar
  28. 28.
    Ruf M, Harms J (2002) Hemivertebra resection by a posterior approach innovative operative technique and first results. Spine 27:1116–1123PubMedCrossRefGoogle Scholar
  29. 29.
    Ruf M, Harms J (2003) Posterior hemivertebra resection with transpedicular instrumentation: early correction in children aged 1to 6 years. Spine 28:2132–2138PubMedCrossRefGoogle Scholar
  30. 30.
    Dove J, Hsu LC, Yau AC (1981) Spontaneous cervical spine fusion: a complication of halo-pelvic traction. Spine 6:45–48PubMedCrossRefGoogle Scholar
  31. 31.
    Xuenong Zou, Haisheng Li, Niels Egund et al (2004) Inhibition of spinal fusion by use of a tissue ingrowth inhibitor. Eur Spine J 13:157–163CrossRefGoogle Scholar
  32. 32.
    Moe JH, Cummine JL, Winter RB et al (1979) Harrington instrumentation without fusion combined with the Milwaukee brace for difficult scoliosis problems in young children. Orthop Trans 3:59Google Scholar
  33. 33.
    Moe JH, Kharrat K, Winter RB et al (1984) Harrington instrumentation without fusion plus external orthotic support for the treatment of difficult curvature problems in young children. Clin Orthop 185:35–45PubMedGoogle Scholar
  34. 34.
    Eberle CF (1988) Failure of fixation after segmental spinal instrumentation without arthrodesis in the management of paralytic scoliosis. J Bone Joint Surg Am 70:696–703PubMedGoogle Scholar
  35. 35.
    Fist JR, Peterson HA, Laughlin R et al (1995) Spontaneous fusion in scoliosis after instrumentation without arthrodesis. J Pediatr Orthop 15:182–186Google Scholar
  36. 36.
    Upadhyay SS, Saji MJ, Sell P et al (1996) The effect of age on the change in deformity after anterior debridement surgery for tuberculosis of the spine. Spine 21:2356–2362PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Hong-Qi Zhang
    • 1
  • Yu-Xiang Wang
    • 1
  • Chao-feng Guo
    • 1
  • Di Zhao
    • 1
  • Ang Deng
    • 1
  • Jian-Huang Wu
    • 1
  • Jin-Yang Liu
    • 1
  1. 1.Department of Spine Surgery, Xiangya Spinal Surgery CenterXiangya Hospital of Central South UniversityChangshaChina

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