Chatterjee Sandip, Banta Aditya
Neurosciences Division, Park Clinic, 4 Gorky terrace, AJC Bose Road, Kolkata, 700017, India.
Childs Nerv Syst. 2018 Oct;34(10):1937-1945. doi: 10.1007/s00381-018-3891-x. Epub 2018 Jul 13.
Pediatric spinal tuberculosis is characterized by rapid bone destruction and carries the risk of rapid onset neurological deficits and severe deformity of the spine. Behavior of spinal deformity over time is affected by growth of spine. Owing to this dynamic behavior of pediatric spinal tuberculosis both in active phase and in healed phase, it presents with challenges which are quite different from adults with caries spine. A clinician must have high index of suspicion for accurate and early diagnosis of spinal tuberculosis in the pediatric population and should also have a thorough knowledge of differences in natural history between adult and pediatric spinal tuberculosis.
This is based on the senior author's experience of dealing with tuberculosis of the spine in children over the last two decades. Recent advances in field of rapid diagnosis of tuberculosis based on nuclear material-related diagnostic tests have further improved the management of tuberculosis. At the same time, the basic treatment principles remain the same. However, the threshold for surgical vs conservative treatment have subtle differences when compared to adult population. The importance of long-term follow-up after treatment must be appreciated.
Tuberculosis in the spine in children needs early attention. Prompting to diagnostic and medical therapy measures can avoid neurological sequellae and delayed deformity.
儿童脊柱结核的特点是骨质破坏迅速，存在迅速出现神经功能缺损和脊柱严重畸形的风险。脊柱畸形随时间的变化受脊柱生长的影响。由于儿童脊柱结核在活动期和愈合期均具有这种动态特性，其面临的挑战与成人龋齿性脊柱截然不同。临床医生必须对儿童人群脊柱结核的准确早期诊断保持高度怀疑指数，还应全面了解成人和儿童脊柱结核自然史的差异。
这基于资深作者在过去二十年中处理儿童脊柱结核的经验。基于核物质相关诊断测试的结核病快速诊断领域的最新进展进一步改善了结核病的管理。同时，基本治疗原则保持不变。然而，与成人相比，手术与保守治疗的阈值存在细微差异。必须认识到治疗后长期随访的重要性。
儿童脊柱结核需要早期关注。及时采取诊断和药物治疗措施可避免神经后遗症和延迟性畸形。
