Hendriarto Andra, Juliandri Refky, Hartanto Bernadus Riyan
Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Indonesia.
Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Indonesia.
Int J Surg Case Rep. 2025 Jan;126:110638. doi: 10.1016/j.ijscr.2024.110638. Epub 2024 Nov 22.
Spinal Tuberculosis (TB), or Pott's disease, is a significant form of extrapulmonary TB affecting the spine, especially in children. Standard treatments include anti-tuberculosis medications, immobilization, and surgery. The use of Gardner well tongs (GWT) in pediatrics spinal TB is rare due to associated risks and lack of supporting evidence. This case report aims to document the application of GWT traction in conjunction with surgical intervention for a pediatric patient with tuberculosis spondylitis.
An 8-year-old boy presented with progressive weakness in both legs over 2.5 years, culminating in his inability to stand or walk. Physical examination revealed asymmetrical back, gibbus formation, tenderness, limited range of motion, and upper motor neuron neurological deficits. Radiographic imaging showed vertebral body destruction from T1-6, causing an 81-degree kyphotic curve. The patient underwent 5 kg of GWT traction for 2 weeks, resulting in a 10-degree improvement in curvature. Subsequent surgical procedures included laminectomy, posterior stabilization, deformity correction, and post-operative application of a SOMI brace. By discharge, the patient's kyphotic angle had improved from 81 to 63°, and there was notable improvement in motor strength and neurological function.
While surgical intervention is often necessary for vertebral deformity restoration, GWT offers advantages in spinal TB management, such as achieving stable cervical segments without skin incision and aiding gradual kyphotic correction. Serious complications from GWT, like skull perforation or neurovascular damage, are infrequent.
A comprehensive, holistic approach incorporating GWT traction and surgical intervention is essential for improving clinical outcomes in pediatric tuberculosis spondylitis.
脊柱结核，又称波特病，是肺外结核的一种重要形式，影响脊柱，在儿童中尤为常见。标准治疗方法包括抗结核药物治疗、固定和手术。由于相关风险和缺乏支持证据，加德纳氏井式钳（GWT）在小儿脊柱结核中的应用很少。本病例报告旨在记录GWT牵引联合手术干预在一名患有结核性脊柱炎的儿科患者中的应用。
一名8岁男孩在2.5年多的时间里出现双下肢进行性无力，最终无法站立或行走。体格检查发现背部不对称、驼背畸形、压痛、活动范围受限以及上运动神经元神经功能缺损。影像学检查显示T1 - 6椎体破坏，导致81度的后凸畸形。患者接受了2周的5公斤GWT牵引，脊柱后凸角度改善了10度。随后的手术包括椎板切除术、后路稳定术、畸形矫正以及术后应用SOMI支具。出院时，患者的后凸角从81度改善到63度，运动力量和神经功能有显著改善。
虽然手术干预通常是恢复椎体畸形所必需的，但GWT在脊柱结核治疗中具有优势，例如无需皮肤切口即可实现颈椎节段的稳定，并有助于逐渐矫正后凸畸形。GWT引起的严重并发症，如颅骨穿孔或神经血管损伤并不常见。
采用GWT牵引和手术干预相结合的综合、整体方法对于改善小儿结核性脊柱炎的临床结局至关重要。
