Curative observation for the application of the combined posterior and anterior instrumentation at lesion or non-lesion vertebral for pediatric thoracolumbar tuberculosis

English Keywords:Children  Thoracolumbar tuberculosis  Combined posterior and anterior surgical  Diseased segment fixation

English Abstract:

  【Abstract】 Objectives: To investigate the effects of the combined posterior and anterior sugery treatment for thoracolumbar tuberculosis in children, and to observe the adjacent segment′s spontaneous fusion with the instrumentation at or/not diseased level. Methods: 23 children suffered from thoracolumbar tuberculosis were involved in our study, including 11 males and 12 females, all cases had an average age of 11.2±0.6 years (range, 7-14 years). All cases had varying degrees of destruction of vertebral body and kyphosis deformity, 21 cases with abscess formation, 8 cases with nerve dysfunction(Frankel grade: 3 in C, 5 in D). All of them received posterior instrumentation at or/not diseased level, posterolateral fusion, anterior radical debridement, decompression and interbody iliac strut bone graft, and all cases were retrospectively reviewed from April 2000 to May 2011 in our department. 17 cases underwent diseased level instrumentation, and 6 cases underwent instrumentation across the diseased level, and all cases were given the ultra-short-course chemotherapy after operation. The changes of the kyphosis angle, ESR and CRP of all cases were observed. Comprehensive evaluation of fusion status and Frankel grade were also performed in the study. Results: The average duration of the follow-up was 68.43±23.40 months(36-120 months). The ESR and CRP of all cases returned to normal 6 months after operation. The average bone union time at anterior and middle columns was 4.26±0.81 months. In the cases with diseased level instrumentation, the average correction rate of kyphosis was (72±5)%, with the loss of correction of 1.29°±0.85°, a total of 28 diseased levels was fixed and fused, and a total of 30 segments got fusion at final follow-up, the spontaneous fusion was noted in 2 segments. In the cases with instrumentation across the diseased level, the average correction rate was (77±6)%, with the loss of correction of 1.00°±1.10°, a total of 10 segments was fixed and fused, while a total of 25 segments got fusion at final follow-up, the spontaneous fusion was noted in 15 segments. 8 cases with neurological deficit recovered to Frankel grade E at final follow-up. Conclusions: The combined posterior with anterior surgery is reliable for pediatric thoracolumbar tuberculosis, which can effectively maintain the growth balance between the anterior column and posterior column of diseased vertebra. Instrumentation at diseased level can decrease the incidence of spontaneous fusion at adjacent nonsurgical segment.