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Female, 4 years, T11 and T12, L1 TB with paravertebral cold abscess formation. Preoperative X-ray AP and lateral view, kyphotic Cobb angle of 45°; preoperative two-dimensional sagittal CT, T12 and L1 vertebral severe destruction; preoperative MR, spinal cord was compressed at the T12, L1 level; Intraoperative images, anterior TB lesion debridement, titanium mesh implantation with autologous bone graft + posterior pedicle osteotomy and pedicle screw fixation; postoperative X-ray AP and lateral view, pedicle screws fixation at T10, T11, T12, L2, L3, autogenous bone grafting and fusion range limited between T11, T12 and L2 with kyphotic Cobb angle 8°; postoperative X-ray AP and lateral view 24 months postoperatively, T10, L3 pedicle screws were removed, keeping T11, T12, L2 vertebral pedicle screw fixation; successfully bone fusion range limited between T11, T12, and L2 with kyphotic Cobb angle 8°
Source publication
Objective
Fifty-four juvenile cases under 18 years of age with thoracic and lumbar spinal tuberculosis underwent focus debridement, deformity correction, bone graft fusion, and internal fixation. The treatment effects, complications, and reasons were analyzed retrospectively.
Material and method
There were 54 juvenile cases under 18 years of age w...
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Citations
... 5 Development of severe kyphosis is commoner complication in children with spinal TB than in adults. Severe kyphosis occurs approximately in 5% of patients with spinal TB. 6 Kyphosis is not only a cosmetic deformity but can also trigger psychological issues, cardiorespiratory problems and late onset paraplegia. 7 The progression of kyphosis following the healing of the tubercular lesion and the physiological growth in children can be difficult to manage. ...
... 13,14 He QY et al have stated that in patients less than 18 years old with spinal TB, there is a likelihood of involvement of more spinal segments. 6 This is attributed to the arrangement of vascular and lymph channels in the annulus fibrosus and the end plate cartilage. Loose-fitting attachment of the prevertebral fascia and periosteum to the vertebral body has also been highlighted as another possibility. ...
Study Design
Systematic Review and Meta-analysis
Objectives
This systematic review and meta-analysis is aimed to assess effectiveness, safety, clinical, functional and radiological outcome of either combined anteroposterior or posterior-only approach in the surgical management of active tubercular disease of paediatric thoracolumbar spine.
Methods
A systematic literature search through PubMed, Scopus, Web of Science and Cochrane Library database was performed. Data extraction was undertaken following methodological quality assessment.
Results
9 out of the 182 publications identified, were included for analysis. A total of 247 patients were analysed. Two amongst the 9 studies were retrospective comparative studies evaluating posterior approach with combined anteroposterior approach and were considered for comparative meta-analysis. Blood loss and duration of surgery was significantly higher in the anteroposterior group, as compared to the posterior-only group. There was no significant difference between the 2 groups in terms of post-operative kyphosis angles, final kyphosis angles, number of complications, functional outcome and spinal fusion time. However, all the included studies were non-randomised and retrospective. Only 2 of them had a control group with a high heterogeneity amongst these 2 studies.
Conclusion
The inference from the studies included in this review suggests that equivalent results can be achieved with posterior-only approach for thoracolumbar tuberculosis in children as compared to anteroposterior approach, with much lower complexity, reduced blood loss and shorter surgical time. However, due to the high risk of bias and considerable heterogeneity among the studies included, we cannot conclude whether one approach is better than the other.
... Ранее было показано, что инфекционные осложнения при хирургическом лечении ТС связаны с поздним выявлением заболевания, неэффективностью и необоснованностью длительной консервативной терапии, ошибками операционного планирования, риском прогрессирования инфекции и ортопедическими осложнениями [6]. Кроме того, рядом исследователей продемонстрировано, что у больных распространенными и осложненными формами ТС (неврологические нарушения, натечные абсцессы, нарушения функции тазовых органов, нейротрофические пролежни и свищи) послеоперационные осложнения возникали чаще, чем в группе с неосложненной формой [7][8][9][10]. ...
The aim of the study was to study comorbidity in HIV (+) and HIV (–) patients with tuberculosis spondylitis (TS) and to assess the influence of certain perioperative risk factors on the formation of early and late postoperative infectious complications.
Materials and methods . A retrospective analysis of 274 patients with TS was performed: 116/43.2% of patients HIV (+) (group 1) and 158/57,7% HIV (–) (group 2). We studied the risk factors for postoperative complications: age, alimentary disorders, concomitant diseases, and the risk of surgical intervention on the ASA scale.
Research result. TC patients in 88,3% of cases had comorbidities (ASA Class 3–4). Early and late infectious complications were 1,5–2 times more common in TC patients with ASA Class 4 than in ASA Class 3. In the HIV (+) group, early infectious complications prevailed, while in HIV (–) patients, these complications occurred with the same frequency. Late postoperative complications were 3–5 times more common in HIV (+) patients (OR=2,84 and OR=8,56, respectively).
... Maximum improvement was seen in first six months as per the VAS score. Qing-Yi et al. [17] reported similar improvement in VAS score in their study of treatment effect and postoperative complication in 54 patients of thoracic and lumbar spinal tuberculosis.5 In their study VAS score of 7.8±1.7 improved to 3.2±2.1 at the last follow up. ...
... Surgical management in Pott's disease depends upon the site of the lesion, extent of deformity and mass effect on adjacent neurological structures [2,9,10,11]. The clinical response to surgery is also faster and more complete in patients with active disease compared with those with chronic disease and deformity. ...
Introduction:
Tuberculosis spondylitis or Pott's disease is the most common destructive form of skeletal tuberculosis. The most commonly affected site is the thoracolumbar vertebra. Once invading the adjacent structures of the vertebrae and intervertebral discs ultimately form an abscess causing spinal cord compression, vertebral collapse, and severe kyphotic deformity.
Presentation of case:
We present the first-ever case done in King Fahd Military Medical Complex in Dhahran, Saudi Arabia, of an 18-year-old male diagnosed with tuberculosis spondylitis who was complaining of progressive upper back pain and lower limb weakness. Emergent anterior decompression with expandable cage, plates, and screws were done. The patient showed a smooth and rapid recovery and was discharged with improved lower limb power and sensations.
Discussion:
Pott's disease can lead to progressive neurological deficits in which surgical decompression is indicated. Current surgical practice includes anterior or posterior decompression with or without fusion and/or instrumentation.
Conclusion:
Surgery with either anterior or posterior decompression should assure complete clearance of the lesion, correcting the kyphotic deformity that prevents disease progression.
... The author demonstrates good clinical outcomes of three-column spine reconstruction. The most numerous series by He et al. [18] included 54 TB spondylitis' children with average age 9 years 2 months. The authors have limited follow-up parameters by dynamic of neurological disorders and postoperative kyphosis correction and focused on the high level of postoperative complications (31.5%; 17 from 54 patients) most often related to apical deformity recurrence and PJK (proximal adjacent kyphosis)-six and eight cases from 17, respectively. ...
Purpose
To evaluate the influence of anterior fusion option on the short- and long-time outcomes on multilevel spinal reconstructions in young children.
Methods
Forty-five patients aged under 4 years old (2 years 2 months ± 11 months in average) underwent spinal reconstruction due to tuberculosis spondylitis (35), pyogenic spondylitis (9) and spinal tumors (1) complicated by angular kyphosis exceeded 20° (49.2° ± 14.3° in average). All lesions involved two or more spinal motion segments. Clinical and radiographic data were compared in two groups depended on the types of anterior fusion: titanium mesh cage with bone graft (TMC + BG) (19 patients) and cortical BG only (26). The average follow-up was 5 years 10 months ± 2 years 8 months (min = 3 years; max = 12 years).
Results
The deformity correction was similar in groups. The operation time and blood loss were less in TMC + BG group (p = 0.001) as a times for anterior bone block formation (p < 0.001) and posterior instrumentation removal (p = 0.003). Ten late post-op complications registered include disease’s recurrence (1), pseudoarthrosis (6), deformity progression (1) and graft resorption (1). The complication rate was less in TMC + BG than in BG group: two and eight cases consequently, p = 0.024.
Conclusions
Multilevel spinal reconstruction in early aged patients is safe and effective procedure. The anterior fusion by TMC with bone autograft has advantages of reducing blood loss, operation time, time for anterior block formation and complications rate compared with bone autograft only.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material. Open image in new window
... Qing-Yi et al reported similar improvement in VAS score in their study of treatment effect and postoperative complication in 54 patient of thoracic and lumbar spinal tuberculosis. 5 In their study VAS score of 7.8±1.7 improved to 3.2±2.1 at the last follow up. ...
p class="abstract"> Background: There are no adequate data in literature referring to the early diagnosis and treatment (especially surgical) of MDR tuberculosis of spine and evaluation of its clinical outcome. We aimed to address this lacunae, by using gene expert test (CBNAAT) and drug sensitivity/susceptibility tests (DST) and by studying subsequent actual clinical outcomes.
Methods: Forty patients with clinico-radiological scenario of spinal tuberculosis were evaluated using biochemical, radiological and histo-pathological studies. Anti-tuberculosis treatment was empirically started based on initial clinico-radiological suspicion of spinal tuberculosis. All tissue specimen and intra-operative samples were subjected to CBNAAT, MGIT culture and histopathological examination. Culture of those samples which showed rifampicin resistance on CBNAAT were followed up for DST (Drug Susceptibility Test) and the treatment modified accordingly, if required. All cases were followed up at 3, 6, 9 and 12 months interval.
Results: Out of 40 patients, mycobacterium tuberculosis was detected in 23 patients by CBNAAT. Out of these 23 cases, 20 showed mycobacterium tuberculosis sensitivity to rifampicin and 3 were resistant. Out of these 3 cases, one had culture positive. Sensitivity and negative predictive value of gene expert test in comparison with the culture were 100%. Specificity and positive predictive value were calculated at 58.6% and 47.8% respectively. Accuracy of gene expert in our study was found to be 70%.
Conclusions: Early detection of MDR spinal tuberculosis using highly sensitive CBNAAT test would be helpful to avoid consequences of inappropriate chemotherapy and would result in favourable outcomes.</p
... In this study, 62.5% patients had involvement of 2 levels, 17.5% patients had involvement of 3 levels, 7.5% patients had involvement of one level and 5 patients had involvement of 4 levels. This was comparable to study by Litao Li et al [13] where they found 46% (16 out of 35 cases) involvement of 2 levels their study, and the maximum number of levels involved was 13 in one patient. ...
... These results were comparable with study conducted by Kumar M, et al. Sensitivity of PCR IS6110 in relation to culture and staining in Pott's disease of 65 cases, reported back pain was most common complaints in all 65 patients" in different grades [13] .Similar incidence of neurodeficit (51.4%) and of deformity of 23% was reported by Litao Li et al. [12] . Most of the cases of spinal tuberculosis diagnosed on the basis of x-ray findings and the sensitivity of plain radiograph ranges from 91-99% [14] . ...
... 22 patients followed up for 9 month showed one case with Grade C, 5 Cases with Grade D and rest of 16 Cases with Grade E. Further follow up of 14 patients up to 12 month showed one case with one case with Grade D and rest of 13 cases belongs to Grade E. This was comparable to study conducted Ayush Sharma1 et al, Magnetic Resonance Imaging and Gene Xpert: A Rapid and Accurate Diagnostic Tool for the Management of Tuberculosis of the Spine of 145 patients [9] . This study result was also comparable to study conducted by Litao Li et al. [13] on retrospective analysis of management of drug resistant spinal tuberculosis in 35 patients reported improvement in ASIA scores from 17 cases with Grade Eat the initial presentation to 29 Cases with Grade Eat the final follow up visit. ...
... That is because the control of tuberculosis depends on the anti-tuberculosis drug and improvement of the immune function, and in posterior surgery the lesion can be cleared extensively and the tubercle bacillus focus can be damaged to transfer the tubercle bacillus from resting stage to proliferative stage, which is beneficial to postoperative anti-tuberculosis treatment [10,26]. At present, there is controversy about the surgical regimen of thoracic and lumbar tuberculosis [10,27,28]. ...
Introduction: Thoracic and lumbar tuberculosis significantly affect the health of people and there is controversy on the therapeutic method. Aims: Our objective is to investigate the clinical efficacy of posterior-only decompression, focal clearance, and internal fixation in treatment of thoracic and lumbar tuberculosis. Methods: Totally 53 eligible patients with thoracic and lumbar tuberculosis were selected and divided into group A (27 patients) and group B (26 patients) according to the admission order. In group A, posterior-only focal clearance, pedicle screw fixation, and fusion of titanium web and the grafted bone were applied; while in group B, combined posterior and anterior surgery, namely posterior internal fixation with nail-stick system in the pedicle of vertebral arch to correct abnormalities first and then focal clearance, were applied. The operative time, intra-operative blood losses, drainage time, drainage volumes, and postoperative lengths of stay were compared between the two groups, and the time to fusion of the grafted bone, degree and rate of correction of kyphotic abnormality, and ASIA impairment scale of neurologic function were followed up. Results: The operative time, intra-operative blood loss, drainage time, drainage volume, and postoperative length of stay in the group A were better than the group B, which were statistically significant (all p<0.05). All the patients were followed up for 12 months-23 months. At 1 year after surgery, the time to fusion of the grafted bone was not statistically different between two groups (p>0.05), however, the degree and rate of correction of Cobb angle in the group A were better than the group B, which were statistically significant (both p<0.05). After the surgery, the improvement of neurologic function ASIA classification was not statistically different between two groups (p>0.05). Conclusions: Posterior-only decompression, focal clearance, and internal fixation in treatment of thoracic and lumbar tuberculosis have small operation wound and has definite effects of spinal reshaping and fusion.
... The bibliometric analysis showed that, bone fusion was the next hotspot in the surgical treatment of spinal tuberculosis. [32,33] The outcomes of follow-up showed that posterior and posterior-anterior surgical treatment methods were both viable surgical options for spinal tuberculosis. Interbody fusion and posterior instrumentation were feasible and effective to treat specific tubercular foci as less invasive techniques. ...
Background:
Spinal tuberculosis is the most common form of skeletal tuberculosis. However, there were limited data to evaluate the trend of spinal tuberculosis research. This study aims to investigate the trend of spinal tuberculosis research and compare the contribution of research from different countries and authors.
Methods:
Spinal tuberculosis-related publications from 1994 to 2015 were retrieved from the Web of Science database. Excel 2013, GraphPad Prism 5, and VOSviewer software were used to analyze the search results for number of publications, cited frequency, H-index, and country contributions.
Results:
A total of 1558 papers were identified and were cited 16,152 times as of January 25, 2016. The United States accounted for 15.1% of the articles, 22.3% of the citations, and the highest H-index (33). China ranked third in total number of articles, fifth in citation frequency (815), and ranked seventh in H-index (13). The journal Spine (IF 2.297) had the highest number of publications. The author Jain A.K. has published the most papers in this field (20). The article titled "Tuberculosis of the spine: Controversies and a new challenge" was the most popular article and cited a total of 1138 times. The keyword "disease" was mentioned the most for 118 times and the word "bone fusion" was the latest hotspot by 2015.
Conclusion:
Literature growth in spinal tuberculosis is slowly expanding. Although publications from China are increasing, the quality of the articles still requires improvements. Meanwhile, the United States continues to be the largest contributor in the field of spinal tuberculosis. According to our bibliometric study, bone fusion may be an emerging topic within spinal tuberculosis research and is something that should be closely observed.
