One-stage surgical management for children with spinal tuberculosis by anterior decompression and posterior instrumentation

Abstract

The goal of this study was to assess the efficacy of one-stage surgical management for children with spinal tuberculosis by anterior decompression, bone grafting, posterior instrumentation, and fusion. Between January 2002 and December 2006, 15 cases with spinal tuberculosis were treated with one-stage posterior internal fixation and anterior debridement. All cases were followed-up for an average of 30.3 months (range 12-48 months). The average neurological recovery in the patients was 0.93 grades on the scale of Frankel et al. (Paraplegia 7:179-192, 1969). The average preoperative kyphosis was 36 degrees (range 19-59 degrees ), and the average postoperative kyphosis was 23 degrees (range 15-38 degrees ) at final follow-up. At final follow-up, minimal progression of kyphosis was seen, with an average kyphosis of 27 degrees (range 16-40 degrees ). An average loss of correction of 4 degrees was seen at final follow-up. One-stage surgical management for children with spinal tuberculosis by anterior decompression, bone grafting, posterior instrumentation, and fusion was feasible and effective.

Fig. 1

Preoperative radiographs showing an anterior segmentation defect at L3

Fig. 2

Postoperative radiographs showing placement of autogenous bone graft, supplemented with dorsal fusion with instrumentation. Postoperative segmental kyphosis measures 15°

Fig. 3

Four-year follow-up radiographs showing good incorporation of the autogenous bone graft and maintenance of the correction