Radical Debridement and Spinal Reconstruction using Titanium Mesh Cages (TMC's) in Pediatrics Patients with Pott's Disease and Vertebral Osteomyelitis

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Introduction TB spondylitis and vertebral osteomyelitis frequently occur in the patients of early ages. The tendency to the multilevel damage with total or subtotal lesions of several vertebral bodies leads to the spine collapse and early kyphosis. Radical debridement and autogenous strut-graft fusion have become the “gold standard” for surgery. The introduction of the TMC in adult's spinal surgery has opened up a variety of applications that are realizable as a result of the versatility of the implant. But the use of TMC in pediatrics spinal surgery is controversial, and results have not been published to date. Patients and Methods Study design: cohort analysis. 74 children aged from 7 months till 17 years underwent spinal reconstruction: 5 (10%) in the cervical spine, 32 (46%) in the thoracic spine and 37 (44%) in the lumbar spine. Clinical series include 18 early age patients under 3 years old. Group 1 (n1 = 25) – tuberculous (TB) spondylitis; group 2 (n2 = 49) – chronic nonspecific spondylitis (CNS) and its consequences, including 16 patients with spondylodiscitis. Disease duration in all patients was at least 4 months prior ineffective antimicrobial therapy. The indications for surgery were destruction with vertebral deformity progression, neurological disorders and ineffective chemotherapy with continuing abscesses. All patients had debridement with anterior column reconstruction, posterior instrumentation and fusion by TMC's with bone auto-grafts. The rate of the fusion was assessed by CT at 6 and 12 months after surgery according to the new rating scale graded from 1 (incorrect implant position) to grade 5 (solid fusion with a structural bone block). Results The number of stabilized spinal segments ranged from 2 to 5. Etiology of spondylitis was identified due to bacteriological, molecular genetics and morphological studies of the operational material. No operative complications and no implant-related complications were recorded in the postoperative period. The fusion rate corresponded to grade 3 in 91,1% ( n = 68) at 6 mns post-op and as grade 4 in 93,2% ( n = 69) at the 12 mns post-op. Till the final follow-up (M 36 - mns, min 12 - mns, max – 4 years) a mean segmental loss of correction was 3,7 (0 ÷ 7) degrees. Destabilization of TMC's was detected after surgery only in two cases due to the late infection's reactivation. Conclusion The anterior interbody fusion by TMC's with bone auto-grafts in pediatric spine reconstruction provides reliable spinal stability in both the short-term and long-term period and does not increase the risk of infectious complications in cases of infectious spondylitis' surgery. TMC produce the early anterior fusion and provide the possibility to earlier removing of posterior instrumentation before the disk degeneration inside the instrumented zone in growing spine.