Pediatric Spinal Infections (Chronic)

Abstract

Granulomatous infections of the spine that occur in pediatric patients can be of two types – tuberculous or fungal infections. These infections are common in the developing parts of the world due to poor hygiene, crowded community, lack of access to healthcare, and reduced awareness. In developed countries, children with immunosuppression and immigrant population are more commonly afflicted than the general population. The clinical presentation of chronic granulomatous infections is one of slow onset and chronic progressions with pain, kyphotic deformity, and neurological deficit. Diagnosis is established mainly by radiological investigations and confirmed by typical histopathological findings of granulomatous infections. Uncomplicated tuberculous infections are treated by anti-tubercular chemotherapy with good results. Children with healed tuberculosis need periodic follow-up till completion of growth as there is risk of late kyphosis development. Children at risk of developing severe late deformities can be identified by the classical “spine-at-risk” signs. Surgery is indicated for children with at least two “at risk” signs, severe neurological deficit, extensive vertebral destruction, and kyphosis. Fungal infections are treated expectantly with appropriate anti-fungal agents and surgery is indicated in those with recalcitrant infections and neurological deficit.