One-stage debridement and bone grafting with internal fixation via posterior approach for treatment of children thoracic spine tuberculosis / 中国骨伤

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the outcome of the children with thoracic spine tuberculosis who underwent radical debridement, reconstruction with bone autograft or allograft and internal fixation via posterior approach.</p><p><b>METHODS</b>From June 2005 to December 2010,9 children with thoracic spine tuberculosis underwent radical debridement, reconstruction with bone autograft or allograft and internal fixation via posterior approach including 7 males and 2 females with an average age of 7 years old ranging from 3 to 12 years. The course of the disease ranged from 3 months to 1 year (averaged 6 months). All the patients had continuous thoracic and back pain,intercostal nerve pain and kyphosis deformity, accompanied with low fever,night sweat and pathologic leanness. The predilection sites examined by X-ray, CT or MRI were in T4 to T9 segment. The kyphosis angle ranged from 35 degrees to 72 degrees (averaged 48.2 degrees) before surgery. The ASIA classification was as follows 2 cases at grade B, 5 at grade C, 2 at grade D. All the patients underwent a standard one-stage operation via posterior approach. Radical debridement was performed, then iliac crest bone autograft or allograft was placed and transpedicular screw system internal fixation was done to reconstruct the spinal column. The change of kyphosis angle and fusion of bone grafting were reexamined by X-ray regularly. The neurological function were evaluated according to ASIA classification.</p><p><b>RESULTS</b>There was no injury of blood vessel or spinal cord during the surgery. Nine children were followed-up for 16 to 38 months (averaged 24 months). The tuberculosis symptoms disappeared after surgery and there was no tuberculosis recurrence,incision infection, sinus formation and internal fixation failure in any of these chiildren. ESR reexamination recovered normally. Bony fusion was obtained in all patients and internal fixation position was normal 4 to 8 month postoperatively. The kyphosis angle ranged from 12 degrees to 30 degrees (averaged 19.50) at final followed-up. The function of spinal cord improved postoperatively, the function of spinal cord recovered at different degrees 2 cases at grade C, 2 at grade D, and 5 at grade E.</p><p><b>CONCLUSION</b>The one-stage posterior approach can provide direct and safe access to the lesion. The effect of vertebral canal decompression and kyphosis deformity correction were significantly. The structural iliac crest autograft or allograft and posterior transpedicular screw system could work effectively to stabilize the thoracic junction.</p>