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Abstract

Introduction: Extrapulmonary TB in pediatric patient affects the quality of life and must be considered seriously. Early surgical treatment is needed to eradicate infection, preserve the physis, and simultaneously correct the deformity. The aim of this study is to assess the efficacy of conservative treatment compared to early surgical treatment regarding neurological improvement, kyphotic correction, and pain relieve.

Method: This is a retrospective case series. We reviewed 28 pediatric spine tuberculosis in Dr. Soetomo General Hospital Surabaya, Indonesia during year 2010-2012. All patients have received TB drugs and indicated for surgical treatment, yet the 15 patients did not provide parental consent. These were selected as non-surgical group. Thirteen patients obtained surgical treatment including bone graft, w/o instrumentation (surgical group). All clinical data were collected at the time of diagnosis and a year after treatment. The improvement of kyphotic (thoracic segments) was defined as narrowing of post-treatment Cobb’s angle. Conversely, lordotic improvement (cervical or lumbar segments) was defined as widening Cobb’s angle. Improvement of neurological status (Frankel classification) was analyzed using chi-square test. The deformity correction and pain relieved were analyzed using independent-samples t-test. All statistical analyses were conducted by SPSS-23.

Result: VAS improvement was not significant. Frankle classification in the surgical group was significantly better. The kyphotic deformity correction was 0% (n=8) in the non-surgical group and, 57.1% (n=4) in the surgical group. There lordotic deformity correction was 74.1% (n=4) in non-surgical group and 83.3% (n=5) in surgical group. There is a significant difference of the kyphotic deformity correction between both groups. but no significant difference in lordotic correction.

Conclusion: Surgical management showed better outcomes in the degree of correction (stopped and corrected the kyphosis progression), and also in the neurological improvement.

Keywords: pediatric spine extra pulmonary tuberculosis spinal deformity

References

  1. Mushkin AY, Kovalenko KN. Neurological Complications of Spinal Tuberculosis in Children. Int Orthop. (SICOT). 1999;23:210-212.
  2. Rajasekaran S. The Natural History of Post-Tubercular Kyphosis in Children. J Bone Joint Surg [Br]. 2001;83-B:954-62.
  3. Reid C, Dunn RN. The Surgical Management Of Spinal Tuberculosis In Children And Adolescents. SA Orthop J. 2009 Jan;8(4):56-62.
  4. Qi-Shan H, Zheng C, Hu Y, Yin X, Xu H, Zhang G, et al. One-Stage Surgical Management For Children With Spinal Tuberculosis By Anterior Decompression And Posterior Instrumentation. Int Orthop. (SICOT). 2009;33(5):1385-1390.
  5. Rajasekaran S, Khandelwal G. Drug Therapy in Spinal Tuberculosis. Eur Spine J. 2013;22(suppl. 4):587-593.
  6. Zhang X, Ji J, Liu B. Management Of Spinal Tuberculosis; A Meta Analysis. J Int Med Res. 2013 Oct;41(5):1395-1407.
  7. WHO.int [internet]. WHO Global TB report 2016. Available from: http://www.who.int/tb/publications/global_report/en/
  8. MRC. A 10-Year Assessment Of Controlled Trials Of Inpatient And Outpatient Treatment And Of Plaster Of Paris Jackets For Tuberculosis Of The Spine In Children On Standard Chemotherapy. J Bone Joint Surg [Br]. 1985 Jan;67-B(1).
  9. MRC. Controlled Trial of Short-Course Regimens of Chemotherapy in the Ambulatory Treatment of Spinal Tuberculosis. J Bone Joint Surg [Br]. 1993;75-B:240-8.
  10. Jain AK, Srivastava A, Saini NS, Dhammi IK, Sreenivasan R, Kumar S. Efficacy Of Extended DOTS Category I Chemotherapy In Spinal Tuberculosis Based On MRI-Based Healed Status. Indian J Orthop. 2012 Nov-Dec;46(6):633-639.
  11. Darbyshire J. Five-Year Assessment Of Controlled Trials Of Short Course Chemotherapy Regimens Of 6,9 Or 18 Months’ Duration For Spinal Tuberculosis In Patients Ambulatory From The Start Or Undergoing Radical Surgery. Int Orthop (SICOT). 1999;23:73-81.
  12. Pankaj K, Vijayaraghavan G, Arvind J. Management of Tuberculous Infection of the Spine. Asian Spine J. 2016;10(4):792-800.
  13. Mak KC, Cheung KMC. Surgical Treatment Of Acute TB Spondylitis; Indications And Outcomes. Eur Spine J. 2013;22(suppl. 4):S603-S611.
  14. Garg RV, Somvanshi DS. Spinal Tuberculosis: A Review. J Spinal Cord Med 2011;34(5):440-454.
  15. Gulati Y, Gupta R. Operative Treatment of Tuberculosis of Dorsal and Lumbar Spine. Apollo Medicine. 2005 Jun;2(2).
  16. American Thoracic Society; CDC; Infectious Diseases Society of America. Treatment of tuberculosis. MMWR Recommendation Rep. 2003;52:1–77.
  17. Hoshino A, Hanada S, Yamada H, Mii S, Takahashi M, Mitarai S, et al. Mycobacterium tuberculosis escapes from the phagosomes of infected human osteoclasts reprograms osteoclast development via dysregulation of cytokines and chemokines. Pathogens & Disease. FEMS. 2014;70(1):28-39.
  18. Rajasekaran S, Soundarapandian S. Progression of Kyphosis in Tuberculosis of the Spine Treated by Anterior Arthrodesis. J. Bone Joint Surg., Inc. 1989:71-A(9):1314-23.
  19. Issac PK, Oheneba BA. Surgical Correction of Kyphotic Deformity in Spinal Tuberculosis. Int Orthop. 2012 Feb;36(2):353–357.
  20. Jain AK, Saurabh J. Instrumented Stabilization In Spinal Tuberculosis. Int Orthop (SICOT). 2012;36:285-292.
  21. Dai LY, Jiang LS, Wang W, Cui YM. Single-Stage Anterior Autogenous Bone Grafting and Instrumentation in the Surgical Management of Spinal Tuberculosis. SPINE 2005;30(20):2342-9.
  22. Benli IT, Acaroglu E, Akalin S, Mahmut Kis, Evrim Duman, Un Ahmet. Anterior Radical Debridement And Anterior Instrumentation In Tuberculosis Spondylitis. Eur Spine J. 2003;12(2):224-234.
  23. Chengizhan S, Taylan M, Kaya H, Sen HS, Abakay O, Bulut, M, et al. Spinal Tubercolosis: A Retrospective Chart Review. Acta Medica Mediterranea. 2014;30:725.
  24. Agarwal A, Chandra H, Agarwal A, Singhal N, Kumar S. Anterior Versus Posterior Fixation in Thoracic Tubercular Spine. Journal of US-China Medical Science. 2015;12:35-39.
  25. Jain AK. Simultaneous Anterior Decompression And Posterior Instrumentation Of The Tuberculous Spine Using And Anterolateral Extrapleural Approach. J Bone Joint Surg [Br]. 2008;90-B:1477-81.
  26. Obaid-ur R, Saleem A, Tayyab H. Anterior Surgical Interventions in Spinal Tuberculosis. J Coll Physicians Surg Pak. 2009;19(8):500-505.
  27. Chen YH. Treatment Modalities for Tuberculosis of the Spine: 22 years Experience in East Taiwan. Formosa J Surg. 2013;46(6):189–194.
  28. Kao HK, Yang WE, Shih HN, Chang CH. Physeal Change after Tuberculous Osteomyelitis of the Long Bone in Children. Chang Gung Med J. 2010;33:453-60.

How to Cite

Irianto, K. A. (2018). The rationale of surgical treatment in pediatric spine tuberculosis. Bali Medical Journal, 7(2), 393–398. https://doi.org/10.15562/bmj.v7i2.900
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