The rationale of surgical treatment in pediatric spine tuberculosis

Abstract

Introduction: Extrapulmonary TB in pediatric patient affects the quality of life and must be considered seriously. Early surgical treatment is needed to eradicate infection, preserve the physis, and simultaneously correct the deformity. The aim of this study is to assess the efficacy of conservative treatment compared to early surgical treatment regarding neurological improvement, kyphotic correction, and pain relieve. Method: This is a retrospective case series. We reviewed 28 pediatric spine tuberculosis in Dr. Soetomo General Hospital Surabaya, Indonesia during year 2010-2012. All patients have received TB drugs and indicated for surgical treatment, yet the 15 patients did not provide parental consent. These were selected as non-surgical group. Thirteen patients obtained surgical treatment including bone graft, w/o instrumentation (surgical group). All clinical data were collected at the time of diagnosis and a year after treatment. The improvement of kyphotic (thoracic segments) was defined as narrowing of post-treatment Cobb’s angle. Conversely, lordotic improvement (cervical or lumbar segments) was defined as widening Cobb’s angle. Improvement of neurological status (Frankel classification) was analyzed using chi-square test. The deformity correction and pain relieved were analyzed using independent-samples t-test. All statistical analyses were conducted by SPSS-23. Result: VAS improvement was not significant. Frankle classification in the surgical group was significantly better. The kyphotic deformity correction was 0% (n=8) in the non-surgical group and, 57.1% (n=4) in the surgical group. There lordotic deformity correction was 74.1% (n=4) in non-surgical group and 83.3% (n=5) in surgical group. There is a significant difference of the kyphotic deformity correction between both groups. but no significant difference in lordotic correction. Conclusion: Surgical management showed better outcomes in the degree of correction (stopped and corrected the kyphosis progression), and also in the neurological improvement.