Abstract
BackgroundThere is limited evidence to guide treatment for pediatric cervical spinal tuberculosis with kyphosis (PCSTK). This study retrospectively evaluates the safety, feasibility and efficacy of 360-degree arthrodesis combined with anterior debridement and decompression for treating PCSTK, while simultaneously emphasizing the role of posterior fixation for the correction and maintenance of the kyphosis angle.MethodsFrom May 2006 to December 2012, a total of 12 children with PCSTK underwent 360-degree cervical spinal arthrodesis followed by debridement of focus and decompression of the spinal cord. Data on the angle of kyphosis correction, visual analogue scale scores of pain, the American Spinal Injury Association scoring system of nerve function scores, erythrocyte sedimentation rate (ESR) and body weight were collected at certain periods. Clinical efficacy was evaluated by statistical analysis based on collected data.ResultsAverage follow-up period was 34.3 ± 8.6 months. No postoperative complications related to the instrumentation occurred, and neurologic function improved in various degrees. Preoperative kyphosis angle was 41.4 ± 5.2°, and significantly decreased to -4.9 ± 4.9° after surgery. The correction of kyphosis and loss of correction were 47.1 ± 4.9° and 0.6 ± 1.4°, respectively. Average pretreatment ESR was 49.8 ± 13.2 mm/h, which normalized (8.5 ± 0.6 mm/h) within three months in all patients. Average preoperative visual analogue scale was 6.6 ± 1.6, which decreased to 2.3 ± 1.4 postoperatively and 0.3 ± 0.5 during the final follow-up. Mean preoperative body weight was 25.9 ± 5.1 kg, and body weight was 33.5 ± 4.8 kg at the third month of post-operation. Bone healing was achieved in all patients after a mean period of 5.4 months.Conclusions360-degree arthrodesis combined with anterior debridement and decompression is a safe and effective method for the treatment of PCSTK. For the correction and maintenance of the kyphosis angle, additional posterior fixation is recommended.
Highlights
There is limited evidence to guide treatment for pediatric cervical spinal tuberculosis with kyphosis (PCSTK)
This study aims to evaluate the safety, feasibility and efficacy of single-stage 360-degree cervical spinal arthrodesis combined with anterior debridement and decompression for the treatment of pediatric cervical spinal tuberculosis with kyphosis
Two children suffered from non-active pulmonary tuberculosis and mild tuberculous pleuritis preoperatively, which healed without any particular therapy except for anti-tuberculosis therapy of Cervical spinal tuberculosis (CST)
Summary
There is limited evidence to guide treatment for pediatric cervical spinal tuberculosis with kyphosis (PCSTK). This study retrospectively evaluates the safety, feasibility and efficacy of 360-degree arthrodesis combined with anterior debridement and decompression for treating PCSTK, while simultaneously emphasizing the role of posterior fixation for the correction and maintenance of the kyphosis angle. Upadhyay et al [5] suggested anterior debridement plus autograft/ allograft bone reconstruction in a comparative analysis of the short and long-term results of two surgical procedures. They concluded that anterior radical surgery is better than pure debridement surgery for the improvement of the deformity angle. Apart from this, posterior fixation plays an irreplaceable role in the correction and maintenance of kyphosis for the treatment of CST
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