Faris Muhammad, Permana Galih Indra, Subagio Eko Agus, Bajamal Abdul Hafid
Department of Neurosurgery, Airlangga University - Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia.
Department of Neurosurgery, Airlangga University - Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia.
Int J Surg Case Rep. 2022 Jun;95:107173. doi: 10.1016/j.ijscr.2022.107173. Epub 2022 May 10.
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.
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.
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.
颈胸交界区易受结核杆菌感染，导致脊柱不稳定。同时，颈胸交界区脊柱结核是一种累及C7至T3椎体的疾病，占所有脊柱结核病例的5%。治疗该疾病的手术方法各异，最常用的方法是前后联合入路。本病例报告介绍了该疾病在儿童中罕见的部位，且很少有报道，并采用单阶段后入路对患者进行治疗，取得了良好的临床和影像学效果。
一名15岁女孩，有1个月进行性下肢截瘫病史（1个月内，其肌力从5级降至0级），最初主诉颈部疼痛、下肢逐渐无力以及T4以下感觉减退。脊柱MRI还显示T1至T3椎体结核性脊柱炎以及C5至T3水平巨大的椎旁脓肿。随后，采用单阶段后入路进行了充分减压、清创、稳定性维持与加强以及畸形矫正。
伴有巨大椎旁脓肿的颈胸交界区脊柱结核使手术操作困难，尤其是在儿童患者中。然而，单阶段后入路手术时间短，临床和影像学效果较好。选择合适的手术入路、良好的围手术期规划以及有效的药物治疗改善了患者的病情。
