Basu Saumyajit, Maddali Dheeraj Manikanta
Department of Spine Surgery, Kothari Medical Center, Kolkata, India.
Spine Deform. 2025 Jan;13(1):221-230. doi: 10.1007/s43390-024-00945-5. Epub 2024 Aug 20.
To retrospectively report on the clinical presentation, radiological features, indication, and outcome of surgical management of children with posttubercular spinal deformities with long term outcome.
This retrospective study was conducted in a single center operated by a single surgeon from 2002 to 2022, and data from an electronic medical record was reviewed. The indications for surgery included failure of medical treatment, to prevent deformity (depending on location, extent of bone loss, stabilization patterns (A, B, or C), and the presence of "Spine at Risk" signs) or correct deformity and in the presence of major neurodeficit.
51 children (< 15 years) of mean age 12.5, and mean follow-up of 7 years (2-15) were included. Pain, deformity/instability, and limb weakness were seen in 34 (66.6%) patients (mean mJOA score was 13.44, which improved to 14.7 and 16.8 at immediate postoperative and latest follow-up), with 17 (33.3%) patients presenting with deformity alone. Dorsal affection was commonest (60.8%), followed by lumbosacral (19.6%) and cervical (19.6%), with multilevel/skip lesions seen in four patients. The mean coronal/sagittal Cobb at presentation was 24.2°/40.96°, which improved to 8.2°/25.6° in the immediate and 8.8°/24.8° at the latest follow-up. Gene Xpert positivity was found in 95%, AFB culture positivity in 84%, and histopathology was positive in 91%. All patients had posterior surgery with an additional anterior reconstruction in 6. The complication rate was 5.8% (N = 3); 2 had implant loosening requiring revision surgery, 1 with prolonged discharging sinus with MDR TB, healed with chemotherapy.
Pediatric post-tuberculous spinal deformities require identification of those who are likely to worsen, and close follow-up is mandatory. Failure of medical management, major destruction of vertebral bodies, type C stabilization pattern, and worsening deformity/neurodeficit require surgery with a good outcome.
回顾性报告结核后脊柱畸形患儿的临床表现、影像学特征、手术适应证及手术治疗效果，并观察长期预后。
本回顾性研究于2002年至2022年在由单一外科医生主刀的单中心进行，回顾了电子病历中的数据。手术适应证包括药物治疗失败、预防畸形（取决于病变部位、骨质丢失程度、稳定模式（A、B或C）以及“脊柱高危”体征的存在情况）或矫正畸形以及存在严重神经功能缺损。
纳入51例年龄小于15岁的儿童，平均年龄12.5岁，平均随访7年（2 - 15年）。34例（66.6%）患者出现疼痛、畸形/不稳定和肢体无力（平均日本骨科学会评分13.44分，术后即刻及最新随访时分别改善至14.7分和16.8分），17例（33.3%）患者仅表现为畸形。胸椎受累最为常见（60.8%），其次是腰骶椎（19.6%）和颈椎（19.6%），4例患者存在多节段/跳跃性病变。初诊时冠状面/矢状面Cobb角平均为24.2°/40.96°，术后即刻改善至8.2°/25.6°，最新随访时为8.8°/24.8°。Xpert基因检测阳性率为95%，抗酸杆菌培养阳性率为84%，组织病理学阳性率为91%。所有患者均接受了后路手术，6例患者还进行了前路重建。并发症发生率为5.8%（n = 3）；2例植入物松动需要翻修手术，1例因耐多药结核病出现长期流脓窦道，经化疗后愈合。
小儿结核后脊柱畸形需要识别可能病情恶化的患儿，密切随访必不可少。药物治疗失败、椎体严重破坏、C型稳定模式以及畸形/神经功能缺损加重均需要手术治疗，且手术效果良好。
