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.
BucknerCBLeithiserREWalkerCWAllisonJW: The changing epidemiology of tuberculosis and other mycobacterial infections in the United States: implications for the radiologist. AJR Am J Roentgenol156:255–2641991
CavuşoğluHKayaRATürkmenoğluONTuncerCColakIAydinY: A long-term follow-up study of anterior tibial allografting and instrumentation in the management of thoracolumbar tuberculous spondylitis. J Neurosurg Spine8:30–382008
DyeCScheeleSDolinPPathaniaVRaviglioneMC: Consensus statement. Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country WHO Global Surveillance and Monitoring Project. JAMA282:677–6861999
JainAKDhammiIKPrashadBSinhaSMishraP: Simultaneous anterior decompression and posterior instrumentation of the tuberculous spine using an anterolateral extrapleural approach. J Bone Joint Surg Br90:1477–14812008
PappouIPPapadopoulosECSwansonANMermerMJFantiniGAUrbanMK: Pott disease in the thoracolumbar spine with marked kyphosis and progressive paraplegia necessitating posterior vertebral column resection and anterior reconstruction with a cage. Spine (Phila Pa 1976)31:E123–E1272006
RajeswariRBalasubramanianRVenkatesanPSivasubramanianSSoundarapandianSShanmugasundaramTK: Short-course chemotherapy in the treatment of Pott's paraplegia: report on five year follow-up. Int J Tuberc Lung Dis1:152–1581997
TaluUGogusAOzturkCHamzaogluADomanicU: The role of posterior instrumentation and fusion after anterior radical debridement and fusion in the surgical treatment of spinal tuberculosis: experience of 127 cases. J Spinal Disord Tech19:554–5592006
UpadhyaySSSellPSajiMJSellBYauACLeongJC: 17-year prospective study of surgical management of spinal tuberculosis in children. Hong Kong operation compared with debridement surgery for short- and long-term outcome of deformity. Spine (Phila Pa 1976)18:1704–17111993
ZhangHQGuoCFXiaoXGLongWRDengZSChenJ: One-stage surgical management for multilevel tuberculous spondylitis of the upper thoracic region by anterior decompression, strut autografting, posterior instrumentation, and fusion. J Spinal Disord Tech20:263–2672007