Abstract
Purpose
Various surgical methods have been described for the management of lumbar tuberculous spondylitis in the literature. However, there were few reports on the two-stage surgical treatment of lumbar tuberculosis in children of elementary school age. We present a retrospective clinical study of 14 patients with lumbar and lumbosacral tuberculous spondylitis treated by two-stage surgery (first stage: posterior instrumentation; second stage: anterior debridement and allografting). The purpose is to determine the clinical efficacy of such surgical treatment for lumbar tuberculosis in children.
Method
Our series was comprised 9 males and 5 females with an average age of 7.5 years treated with the abovementioned surgical procedure. All patients had lumbar and lumbosacral involvement with one patient having spondylitis at L2–3, three at L3–4, seven at L4–5, and three at L5–S1. All patients had single motion segment involvement. The Frankel scoring system was used to assess the neurological deficits. Frankel’s grade B in two patients, grade C in four and grade D in eight. The following data were followed-up for an average period of 50.1 months (42–64 months) in these patients: healing of disease, deformity correction and its maintenance, neurologic function, and spinal bony fusion.
Results
The average preoperative local deformity angle was −13.8°, correcting to 3.4° postoperatively and 1.5° at the final follow-up. With the exception of one patient who received a D at the final follow-up, all cases obtained complete neurological recovery. No breakage and looseness of internal fixation was found. Bony fusion was achieved in all cases within 6 months postoperatively. There was no recurrent tuberculous infection.
Conclusion
Two-stage (posterior and anterior) surgery is a safe and effective procedure for the patient of elementary school age suffering from lumbar and lumbosacral tuberculous spondylitis, especially for the patients in poor general condition. The procedure has the advantage of minor surgical invasion, effective kyphosis correction and less complications.
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References
Kumar Raj (2005) Spinal tuberculosis: with reference to the children of northern India. Childs Nerv Syst 21:19–26
Moon MS, Moon YW, Moon JL et al (2002) Conservative treatment of tuberculosis of the lumbar and lower lumbar spine. Clin Orthop 398:40–49
Rajasekaran S, Shanmugasundaram TK, Prabhakar R et al (1998) Tuberculous lesions of the lumbosacral region. A 15-year followup of patients treated by ambulant chemotherapy. Spine 23:1163–1167
Zaveri GR, Mehta SS (2009) Surgical treatment of lumbar tuberculous spondylodiscitis by transforaminal lumbar interbody fusion (TLIF) and posterior instrumentation. J Spinal Disord Tech 22:257–262
British Medical Research Council Working Party on Tuberculosis of the Spine (1993) Controlled trial of short-course regimens of chemotherapy in the ambulatory treatment of spinal tuberculosis: results at three years of a study in Korea. Twelfth report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Jt Surg Br 75:240–248
Lee CK, Vessa P, Lee JK (1995) Chronic disabling low back pain syndrome caused by internal disc derangements. The results of disc excision and posterior lumbar interbody fusion. Spine 20:356–361
Khoo LT, Mikawa K, Fessler RG (2003) A surgical revisitation of Pott distemper of the spine. Spine 3:130–145
British Medical Research Council Working Party on Tuberculosis of the Spine (1998) A 15-year assessment of controlled trials of the management of tuberculosis of the spine in Korea and Hong Kong. Thirteenth Report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Jt Surg Br 80:456–462
Ajasekaran S, Prasad Shetty A, 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 26:716–724
Parathasarathy R, Sriram K, Satha T et al (1999) Short course chemotherapy for tuberculosis of the spine: a comparison between ambulant treatment and radical surgery—ten-year report. J Bone Jt Surg Br 81:464–471
Tuli SM (1995) Severe kyphotic deformity in tuberculosis of the spine. Int Orthop 19:327–331
Pun WK, Chow SP, Luk KD et al (1990) Tuberculosis of the lumbosacral junction. Long-term follow-up of 26 cases. J Bone Jt Surg Br 72:675–678
Lee CK, Vessa P, Lee JK (1995) Chronic disabling low back pain syndrome caused by internal disc derangements. The results of disc excision and posterior lumbar interbody fusion. Spine 20:356–361
Zhang HQ, Wang YX, Guo CF et al (2011) One-stage posterior focus debridement, fusion, and instrumentation in the surgical treatment of cervicothoracic spinal tuberculosis with kyphosis in children: a preliminary report. Childs Nerv Syst 27:735–742
Talu U, Gogus A, 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 19:554–559
Hodgson AR, Stock FE (1960) Anterior spine fusion for the treatment of tuberculosis of the spine: The operative findings and results of treatment in the first 100 cases. J Bone Jt Surg Am 42:295–310
Zhang HQ, Guo CF, Xiao XG et al (2007) One-stage surgical management for multilevel tuberculous spondylitis of the upper thoracic region by anterior decompression, strut autografting, posterior instrumentation, and fusion. J Spinal Disord Tech 20:263–267
Fukuta S, Miyamoto K, Masuda T et al (2003) Two-stage (posterior and anterior) surgical treatment using posterior spinal instrumentation for pyogenic and tuberculotic spondylitis. Spine 28:E302–E308
Hirakawa A, Miyamoto K, Takahiro M et al (2010) Surgical outcome of 2-stage (posterior and anterior) surgical treatment using spinal instrumentation for tuberculous spondylitis. J Spinal Disord Tech 23:133–138
Kim DJ, Yun YH, Moon SH et al (2004) Posterior instrumentation using compressive laminar hooks and anterior interbody arthrodesis for the treatment of tuberculosis of the lower lumbar spine. Spine 29:275–279
Laheri VJ, Badhe NP, Dewnany GT (2001) Single stage decompression, anterior interbody fusion and posterior instrumentation for tuberculous kyphosis of the dorso-lumbar spine. Spinal Cord 39:429–436
Moon MS, Woo YK, Lee KS et al (1995) Posterior instrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal and lumbar spine. Spine 20:1910–1916
Bailey HL, Gabriel M, Hodgson AR et al (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 Jt Surg Am 54:1633–1657
Bridwell KH, Lenke LG, McEnery KW et al (1995) Anterior structural allografts in the thoracic and lumbar spine. Spine 20:1410–1418
Govender S (2003) Cortical allografts in spinal tuberculosis. Int Orthop 27:244–248
Molinari RW, Bridwell KH, Klepps SJ (1999) Minimum 5-year follow-up of anterior column structural allografts in the thoracic and lumbar spine. Spine 24:967–972
Moon MS (2006) Development in the management of tuberculosis of the spine. Curr Orthop 20:132–140
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 22:1150–1155
Younger EM, Chapman MW (1989) Morbidity at bone graft donor sites. J Orthop Trauma 3:192–195
Robertson PA, Wray AC (2001) Natural history of posterior iliac crest bone graft donation for spinal surgery: a prospective analysis of morbidity. Spine 26:1473–1476
Skaggs DL, Samuelson MA, Hale JM et al (2000) Complications of posterior iliac crest bone grafting in spine surgery in children. Spine 25:2400–2402
Betz RR, Lavelle WF, Samdani AF (2010) Bone grafting options in children. Spine 35:1648–1654
Ruf M, Harms J (2002) Pedicle screws in 1- and 2-year-old children: technique, complications, and effect on further growth. Spine 27:E460–E466
Jeszenszky D (2000) Morphological changes of the spinal canal after placement of pedicle screws in newborn pigs. Presented at: Scoliosis Research Society Annual Meeting. Cairns, Australia
Cil A, Yazici M, Daglioglu K et al (2005) The effect of pedicle screw placement with or without application of compression across the neurocentral cartilage on the morphology of the spinal canal and pedicle in immature pigs. Spine 30:1287–1293
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Zhang, H.Q., Li, J.S., Guo, C.F. et al. 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 (2012). https://doi.org/10.1007/s00402-012-1548-x
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DOI: https://doi.org/10.1007/s00402-012-1548-x