Abstract
Aim To analyze the immediate and long-term results of the surgical treatment of infectious spondylitis in children. Materials and methods A retrospective cohort design was implemented with the following inclusion criteria: 1) age below 18 years, 2) titanium mesh block cage for anterior spondylodesis, and 3) follow up period of 24 months. The mean age was 15.3 ± 2.8 years. The patients were divided into two groups according to diagnosis: active tuberculous spondylitis (n1 = 42) and chronic non-specific spondylitis and its consequences (n2 = 41). Results There were no complications or process aggravation within a period of 6 months after surgery. However, there was one case of mesh cage destabilization when tuberculous spondylitis progressed in the period from 6 to 12 months. The amount of kyphosis correction was 26.5° ± 10.1°. The postoperative deformity increase at 18 months after surgery did not exceed 5°. Bone block was estimated at 3 points in 95 % of cases 6 months after surgery and at 4 or 5 points in 97 % of cases 12 months after surgery. Neurological disorders, based on Frankel evaluation before surgery, were identified in 5 patients (Type D in 3 patients, Type B in 2 ), and complete regression was observed after surgery in 4 cases up to Type Е and 1 case up to Type D. Operative blood loss was M ± m = 207.9 ± 139.1. Conclusion The use of titanium mesh block cages in children with infectious spondylitis is a safe procedure that reduces the number of complications in the immediate and long-term postoperative period as well as maintains the stability of surgical correction of the spine deformity.
Highlights
The tendency of multisegmental destruction with a complete or partial destruction of the vertebral bodies involved in the pathological process for specific spondylitus, and monosegmental destruction is involved in the case of non-specific spondylitus;
In accordance with the post-operative examination deadline, no cases of infectious complications or exacerbation of the infectious process were identified six months after surgery; after 12 months, one case of exacerbation of the initial tuberculous spondylitis was registered; and after 24 months, no infectious complications were found
Complications commonly associated with the implanted interbody mesh were not identified in the study groups
Summary
319 surgeries on the spine in children were performed at the clinic. The data of 83 patients corresponding to the inclusion criteria was included in the overall analysis. The average age at the time of the surgery was 15.3 ± 2.8 years (minimum: 7 months; maximum: 17 years). Indications for surgery included: the presence of infectious destruction of the vertebrae; the presence of kyphotic deformation of the spine; neurological disorders; and the ineffectiveness of conservative antibacterial (for non-specific processes) and antituberculous (for specific spondylitis) chemotherapy for at least two months. The average duration of a therapeutic timeout (the time from establishing the diagnosis to surgery) was 16 months (minimum: 4 months; maximum: 13 years)
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