Efficacy and complication of the surgery for thoracic and lumbar spinal tuberculosis in children

English Keywords:Children  Thoracic and lumbar spine tuberculosis  Postoperative complications  Correlation factor

English Abstract:

  【Abstract】 Objectives: To retrospectively analyze the efficacy and complication of the surgery for thoracic and lumbar spinal tuberculosis in children, including focus debridement, deformity correction, bone graft fusion and internal fixation. Methods: From January 2002 to December 2012, 31 children with thoracic or lumbar spinal tuberculosis were retrospectively analyzed, including 20 males and 11 females. All the children were under 12 years old, with an average age of 8.1±2.3 years old. The tuberculosis located in thoracic vertebra in 14 cases, thoracolumbar vertebra in 9 cases, and lumbar vertebra in 8 cases. The Frankel classification at preoperation was B in 3 cases, C in 6 cases, D in 11 cases and E in 11 cases. The surgical procedure was as follows: 3 cases who had only 1 vertebral body damaged or cold abscess around vertebral body with stable spine, underwent focus debridement, bone graft fusion and internal fixation via anterior approach; 18 cases who had more than 2 vertebral bodies damaged with spinal kyphosis deformity, underwent anterior focus debridement and implantation with allograft or autograft in mesh, deformity correction, and posterior fixation with pedicle screws; 5 cases who had more than 3 vertebral bodies damaged with severe kyphosis deformity and cold abscess spread widely, underwent combined anterior and posterior approach surgery; 4 cases who showed severe kyphosis deformity with less cold abscess and less damaged vertebral bodies, underwent osteotomy and deformity correction; 1 case who had only larger cold abscess and mild vertebral body destruction, underwent focus debridement. Radiographic images, VAS and ODI were applied to evaluate the patients preoperatively and postoperatively. Nerve function was evaluated by Frankel score. Results: The treatment outcomes, complications and bone fusion were observed after an average of 38±11 months. Operations were successfully completed in all the cases, with no aggravated nerve dysfunction. Frankel classification improved to C in 2 cases, D in 3 cases and E in 26 cases at the final follow-up postoperatively. VAS improved from 7.6±1.1 preoperatively to 2.1±1.4 at final follow-up postoperatively, ODI improved from 75.3±12.1 preoperatively to 26.2±12.4 at final follow-up, kyphosis Cobb′s angle improved from 56.0°±2.5° to 35°±1.9° at final follow-up, all of these improved significantly. All the bone grafts were fused which confirmed by two-dimension CT, and the fusion time averaged 6.1±1.1 months. The rate of complications related to the operation was 32%(10/31): 3 cases suffered from aggravation of kyphosis, 5 cases suffered from proximal adjacent kyphosis, 1 case suffered from pedicle penetration, 1 case suffered from recurrence of tuberculosis. The patients with complications had younger age, more involving segments and longer course of disease than patients without complications. All the patients with complications recovered after extension of segmental fixation and revised surgery. Conclusions: The main complications of treating spinal tuberculosis in children are the proximal adjacent kyphosis and aggravation of kyphosis in fixed segments. Complications are related to patient′s age, number of involving segments and the length of disease course.