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

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Abstract

Purpose

The purpose of this study was to determine the efficacy and feasibility of surgical management of children with thoracolumbar spine tuberculosis with kyphosis by using one-stage posterior focus debridement, interbody grafts, and posterior instrumentation and fusion.

Methods

From October 2010 to September 2013, 21 children with thoracolumbar spinal tuberculosis accompanied by kyphosis were treated with one-stage posterior decompression, interbody grafts, and posterior instrumentation and fusion. There were 13 males and 8 females, aged from 7 to 13 years old (average age 9.9 years). The mean follow-up was 34 months (range26–48 months). Patients were evaluated before and after surgery in terms of ESR, neurologic status, pain, and kyphotic angle.

Results

Spinal tuberculosis was completely cured, and the grafted bones were fused in all 21 patients. There was no recurrent tuberculous infection. ESR got normal within 3 months in all patients. The ASIA neurologic classification improved in all cases. Pain relief was obtained in all patients. The average preoperative kyphosis was 29.7° (range 12–42°) and decreased to 5.5° (range 2–10°), postoperatively. There was no significant loss of the correction at the latest follow-up.

Conclusions

Our results show that one-stage posterior decompression, interbody grafts, and posterior instrumentation and fusion were an effective treatment for children with thoracolumbar spinal tuberculosis. It is characterized as minimum surgical trauma, good neurologic recovery, good correction of kyphosis, and prevention of progressive kyphosis.

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References

  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:954–962

    Article  Google Scholar 

  2. Leong JC (1993) Tuberculosis of the spine. J Bone Joint Surg (Br) 75:173–175

    CAS  Google Scholar 

  3. Rajasekaran S, Soundarapandian S (1989) Progression of kyphosis intuberculosis of the spine treated by anterior arthodesis. J Bone Joint Surg Am 71:1314–1323

    CAS  PubMed  Google Scholar 

  4. Jain AK (2007) Tuberculosis of the spine. Clin Orthop Relat Res 460:39–49

    Article  PubMed  Google Scholar 

  5. Tuli SM (2007) Tuberculosis of the spine: a historical review. Clin Orthop Relat Res 460:29–38

    CAS  PubMed  Google Scholar 

  6. Talu U, Gogus A, Ozturk C, Hamzaoglu A, Domanic U (2006) The Role of Posterior instrumentation andFusion After Anterior Radical Debridement and Fusion in the Surgical Treatment of Spinal Tuberculosis: Experience of 127 Cases. J Spinal Disord Tech 19:554–559

    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

    Article  PubMed  PubMed Central  Google Scholar 

  8. Zhang HQ, Li JS, Guo CF, Liu SH, Tang MX, Wang YX, Deng A, Le Gao Q, Lin MZ (2012) Two-stage surgical management using posterior instrumentation, anterior debridement and allografting for tuberculosis of the lower lumbar spine in children of elementary school age: minimum 3-year follow-up of 14 patients. Arch Orthop Trauma Surg 132:1273–1279

    Article  PubMed  Google Scholar 

  9. Murrey DB, Brigham CD, Kiebzak GM, Finger F, Chewning S (2002) Transpedicular decompression and pedicle subtraction osteotomy (egg shell procedure): a retrospective review of 59 patients. Spine 27:2338–2345

    Article  PubMed  Google Scholar 

  10. Rajasekaran S, Prasad Shetty A, Dheenadhayalan J, Shashidhar Reddy J, Naresh-Babu J, Kishen T (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 26:716–724

    Article  CAS  PubMed  Google Scholar 

  11. Rezai AR, Woo HH, Errico TJ, Cooper PR (1999) Contemporary management of spinal osteomyelitis. Neurosurgery 44:1018–1025

    Article  CAS  PubMed  Google Scholar 

  12. Przybylski GJ, Sharan AD (2001) Single-stage autogenous bone grafting and internal fixation in the surgical management of pyogenic discitis and vertebral osteomyelitis. J Neurosurg 94(Suppl 1):1–7

    CAS  PubMed  Google Scholar 

  13. Bailey HL, Gabriel M, Hodgson AR, Shin JS (1972) Tuberculosis of the spine in children.Operative findings and results in one-hundred consecutive patients treated by removal of the lesion and anterior grafting. J Bone Joint Surg Am 54:1633–1657

    CAS  PubMed  Google Scholar 

  14. Hodgson AR, Stock FE (1956) Anterior spinal fusion. A preliminary communication on the radical treatment of Pott’s disease and Pott’s paraplegia. Br J Surg 44:1266–1275

    Article  Google Scholar 

  15. Hodgson AR, Stock FE (1994) The classic anterior spinal fusion. A preliminary communication on the radical treatment of Pott’s disease and Pott’s paraplegia. Clin Orthop 300:16–23

    PubMed  Google Scholar 

  16. Fountain SS, Hsu LC, Yau AC, Hodgson AR (1975) Progressive kyphosis following solid anterior spine fusion in children with tuberculosis of the spine. J Bone Joint Surg Am 57:1104–1107

    CAS  PubMed  Google Scholar 

  17. Baker WC, Thomas TG, Kirkaldy-Willis WH (1969) Changes in the cartilage of the posterior intervertebra1 joints after anterior fusion. J Bone Joint Surg 51B:736–746

    Google Scholar 

  18. Altman GT, Altman DT, Frankovitch KF (1996) Anterior and posterior fusion for children with tuberculosis of the spine. Clin Orthop Relat Res 325:225–231

    Article  PubMed  Google Scholar 

  19. Mehta JS, Bhojraj SY (2001) Tuberculosis of the thoracic spine: a classification based on the selection of surgical strategies. J Bone Joint Surg (Br) 83:859–863

    Article  CAS  Google Scholar 

  20. 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

    Article  PubMed  Google Scholar 

  21. Güzey FK, Emel E, Bas NS, Hacisalihoglu S, Seyithanoglu MH, Karacor SE, Ozkan N, Alatas I, Sel B (2005) Thoracic and lumbar tuberculous spondylitis treated by posterior debridement,graft placement,and instrumentation:a retrospective analysis in 19 cases. J Neurosurg Spine 3:450–458

    Article  PubMed  Google Scholar 

  22. 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 38:926–933

    Article  CAS  PubMed  Google Scholar 

  23. Chen YC, Chang MC, Wang ST, Yu WK, Liu CL, Chen TH (2003) One-stage posterior surgery for treatment if advanced spinal tuberculosis. J Chin Med Assoc 66:411–417

    PubMed  Google Scholar 

  24. Zheng CK, Huang QS, Hu YZ (2008) Current state and development in surgical treatment for children with spinal tuberculosis. Zhongguo Gu Shang 21:641–643

    PubMed  Google Scholar 

  25. Jain AK (2002) Treatment of tuberculosis of the spine with neurologic complications. Clin Orthop Rel Res 398:75–84

    Article  Google Scholar 

  26. 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

    Article  CAS  PubMed  Google Scholar 

  27. Bezer M, Kucukdurmaz F, Aydin N, Kocaoglu B, Guven O (2005) Tuberculous Spondylitis of the Lumbosacral Region Long-Term Follow-Up of Patients Treated by Chemotherapy, Transpedicular Drainage, Posterior Instrumentation, and Fusion. J Spinal Disord Tech 18:425–429

    Article  PubMed  Google Scholar 

  28. Nene A, Bhojraj S, FCPS (2005) Results of nonsurgical treatment of thoracicspinal tuberculosis in adults. Spine J 5:79–84

    Article  PubMed  Google Scholar 

  29. Rajasekaran S (2002) The problem of deformity in spinal tuberculosis. Clin Orthop Relat Res 398:85–92

    Article  PubMed  Google Scholar 

  30. Chacko AG, Moorthy RK, Chandy MJ (2004) The transpedicular approach in the management of thoracic spine tuberculosis: a short-term follow up study. Spine 29:363–367

    Article  Google Scholar 

  31. Lönnroth K, Raviglione M (2008) Global epidemiology of tuberculosis: prospects for control. Semin Respir Crit Care Med 29:481–491

    Article  PubMed  Google Scholar 

  32. Sala F, Kržan MJ, Deletis V (2002) Intraoperative neurophysiological monitoring in pediatric neurosurgery: why, when, how? Childs Nerv Syst 18:264–287

    Article  PubMed  Google Scholar 

  33. Hyun SJ, Rhim SC, Kang JK, Hong SH, Park BR (2009) Combined motor- and somatosensory-evoked potential monitoring for spine and spinal cord surgery: correlation of clinical and neurophysiological data in 85 consecutive procedures. Spinal Cord 47:616–622

    Article  CAS  PubMed  Google Scholar 

  34. Ben-David B, Haller G, Taylor P (1986) Anterior spinal fusion complicated by paraplegia: a case report of a false negative somatosensory evoked potential. Science 12:536–539

    Google Scholar 

  35. Costa P, Bruno A, Bonzanino M, Massaro F, Caruso L, Vincenzo I, Ciaramitaro P, Montalenti E (2007) Somatosensory- and motor-evoked potential monitoring during spine and spinal cord surgery. Spinal Cord 45:86–91

    Article  CAS  PubMed  Google Scholar 

  36. Park J-H, Hyun S-J (2015) Intraoperative neurophy- siological monitoring in spinal surgery. World J Clin Cases 3:765–773

    Article  PubMed  PubMed Central  Google Scholar 

  37. Ruf M, Harms J (2002) Pedicle Screws in 1- and 2-Year-Old Children: Technique, Complications, and Effect on Further Growth. SPINE 27:460–466

    Article  Google Scholar 

  38. Ruf M, Harms J (2003) Posterior Hemivertebra Resection With Transpedicular Instrumentation: Early Correction in Children Aged 1to 6 Years. SPINE 28:2132–2138

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. From the Department of Spine Surgery, Xiangya Spinal Surgery Center, Xiangya Hospital of Central South University, ChangSha, China

    Yu-Xiang Wang, Hong-Qi Zhang, Ming-xing Tang, Chao-feng Guo, Ang Deng, Jian-Huang Wu, Jin-Yang Liu, Zhansheng Deng & Jing Chen

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  1. Yu-Xiang Wang
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Correspondence to Hong-Qi Zhang.

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Wang, YX., Zhang, HQ., Tang, Mx. et al. One-stage posterior focus debridement, interbody grafts, and posterior instrumentation and fusion in the surgical treatment of thoracolumbar spinal tuberculosis with kyphosis in children: a preliminary report. Childs Nerv Syst 32, 1495–1502 (2016). https://doi.org/10.1007/s00381-016-3152-9

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  • DOI: https://doi.org/10.1007/s00381-016-3152-9

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