Surgical treatment of thoracic Pott disease in a 3-year-old child, with vertebral column resection and posterior-only circumferential reconstruction of the spinal column

Case report

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Tuberculosis (TB) is a common disease worldwide that is caused by Mycobacterium tuberculosis. Tuberculosis of the spine, also called Pott disease, is the most common site of bony dissemination. Although children are disproportionately affected, spinal TB is nonetheless rare in very young children. Cases involving infants requiring surgical intervention have been previously reported, and they are often associated with greater management challenges given the technical difficulty with instrumentation in very young children.

This case involved a 3-year-old girl with TB centered at T-6, who presented with myelopathy from spinal cord compression and a severe kyphotic deformity (> 60°). She underwent a single-stage costotransversectomy for vertebral column resection, followed by reconstruction with an anterior expandable titanium cage and posterior pedicle screw instrumentation. At last follow-up, the patient was clinically and radiographically stable.

The authors report on the youngest patient with spinal TB treated surgically with this strategy and review the literature regarding prior cases involving young children. Although limited by the paucity of cases in the literature, surgical debridement and spinal fusion appear to provide a safe alternative to prolonged bed rest or casting and may offer additional benefits of a faster recovery and ambulation.

Abbreviations used in this paper:TB = tuberculosis; VB = vertebral body; VCR = vertebral column resection.

Article Information

Address correspondence to: Andrew Jea, M.D., Department of Neurosurgery, 6621 Fannin Street, Clinical Care Center 1230.01, 12th Floor, Houston, Texas 77030. email: ajea@bcm.edu.

Please include this information when citing this paper: DOI: 10.3171/2011.12.PEDS11315.

© AANS, except where prohibited by US copyright law.

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Figures

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    Preoperative CT scans of the thoracic spine, with axial view (left) and sagittal reconstruction (right) demonstrating a kyphotic deformity in the midthoracic region with complete destruction of T-6 and partial collapse of T-5 and T-7.

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    Preoperative T2-weighted MRI studies of the thoracic spine, with axial (left) and sagittal (right) views showing a kyphotic deformity in the midthoracic region, with epidural abscess causing spinal cord compression.

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    Postoperative CT scan of the thoracic spine with sagittal reconstruction obtained at 3 months after surgery showing the anterior expandable titanium cage and posterior instrumentation, with reduction of the kyphotic deformity and bone healing.

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    Postoperative standing full-spine radiograph demonstrating maintenance of sagittal alignment and no evidence of instrumentation failure at 3 months after surgery.

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    Postoperative coronal view (left) and sagittal CT reconstruction (right) obtained at 11 months showing osseous fusion incorporating and bridging the instrumentation construct.

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