Clinical evaluation and surgical treatment of thoracolumbar kyphosis secondary to childhood spinal tuberculosis

Abstract

Objective To discuss the surgical strategy and efficacy for thoracolumbar kyphosis secondary to spinal tuberculosis (TB) in children. Methods Fourteen patients were enrolled in this study,including 11 females and 3 males with an average age of 11.8 years (range,4 to 18 years). Thoracolumbar kyphosis was present in all patients. Six patients were diagnosed with active spinal TB and the other 8 with healed spinal TB. In the 6 patients with active TB,3 patients were treated by sin-gle-stage anterior spinal debridement and fusion; and the other 3 underwent two-stage corrective oper-ations,by which posterior transpedicular osteotomy was performed in the first stage,and anterior de-bridement and strut graft fusion was performed in the second stage 2 weeks later. In the 8 patients with healed TB,3 patients underwent single-stage posterior in situ spinal fusion; 2 underwent single-stage posterior tranpedicular osteotomy; and the other 3 patients were performed with posterior total vertebrae resection in first stage,and anterior strut graft spinal fusion in second stage 2 weeks later. The kyphos and deformity angles were measured preoperatively and postoperatively on the lateral spi-nal radiographs,and were followed up after patients were discharged. Results All the patients were followed up,with a mean follow-up period of 25 months (range,6 to 48 months). No TB lesion re-currence,sinus tract,infection or neurological deficit was noted. In the 6 patients with active spinal TB. In the 6 patients with active spinal TB,the mean kyphosis was 46° before surgery,it was correc-ted to 20° after surgery,and 22° at final follow-up; the mean deformity angle was 47°,it was improved to 25° after surgery,and 27° at final follo'w-up. In the 8 patients with healed spinal TB,the mean ky-phosis was 50° before surgery,it was corrected to 44° after surgery,and 47° at final follow-up; the mean deformity angle was 42°,it was improved to 34° after surgery,and 36° at final follow-up. Con-clusions To achieve good clinical outcomes,the option for surgical strategy for thoracolumar kyphosis caused by TB in children should be based on patients' radiographic and clinical fea-tures. Key words: Child; Tuberculosis,spinal; Kyphosis