Surgical treatment approach of cervicothoracic junction spinal tuberculosis in pediatric: A case report

Abstract

Introduction and importance: The cervicothoracic junction is prone to infection by tuberculosis bacteria, which leads to spinal instability. Meanwhile, cervicothoracic junction spinal tuberculosis is a disease that affects the C7 to T3 vertebral, and it accounts for 5% of all spinal tuberculosis cases. Surgical procedures of treating this disease vary, and the most commonly used method is the combined anterior and posterior approach. This case report presents the disease with uncommon location in pediatric, which is rarely reported, and performed with the single-stage posterior approach to treat the patient, which showed a good clinical and radiological result.

Case presentation: A 15-years old girl with one-month history of progressive inferior paraplegia (within a month, her muscle strength went from score 5 to 0) initially complained of neck pain, gradual weakness of the lower extremities, and hypoesthesia below T4. The spine's MRI also showed a tuberculous spondylitis in the T1 to T3 vertebral and a huge paravertebral abscess at the C5 to T3 level. Subsequently, an adequate decompression, debridement, maintenance and reinforcement of stability as well as deformity correction were carried out using the single-stage posterior approach.

Conclusions: The cervicothoracic junction spinal tuberculosis with huge paravertebral abscess makes surgical procedures difficult, specifically in pediatric patients. However, the single stage posterior approach produced a better clinical and radiological result with a short operation time. The selection of appropriate surgical approach management with good perioperative planning as well as effective medical management improved the patient's condition.

Keywords: Cervicothoracic junction; Pediatric; Posterior approach; Spinal tuberculosis.

Fig. 1

A 15-years old girl patient clinically presented with gibbus (↑) in the cervicothoracic junction in the posterior view (A) and lateral view (B).

Fig. 2

MR imaging of axial (A) at the level vertebral T3 and sagittal (B) views showed a large paravertebral abscess (↑) in the anterior of the level vertebral C5 to T3. In the sagittal view (B), vertebral body destruction and spinal cord compression at the level of vertebral T1 to T3.

Fig. 3

Spinal cord compression due to vertebral body destruction at the level of vertebral T1 to T3. The paravertebral abscess has drained from posterior approach (↑).

Fig. 4

Preoperative MRI (A) and postoperative radiograph (B) demonstrated decreased of the Cobb angle from 42° to 11° and sagittal vertical axis (SVA) from 5.9 cm to 1.9 cm that resulted in improved kyphotic deformity.