Tuberculosis of the spine in children

ABSTRACT

Tuberculous spondylitis or Pott's disease results in characteristic deformity. In developed counties, Pott's disease occurs primarily in older adult rather than children. In developing countries where the infection rate is high, it occurs mainly among children. We have reviewed the hospital records of pediatrics ward with diagnosis of tuberculosis between 1995 and 2001. There were seven children with the diagnosis of Pott's disease. The age of the patients ranged from 7 to 14 years with mean of 11.14 years. All of them were Afghans. In four cases, spine was the main affected site, in two patients disseminated tuberculosis was seen; and in 1 case, spinal involvement was associated with pulmonary tuberculosis. Of them, five patients had paraspinal abscess. Fistula was formed in the lumbar region of 2 patients. Abscess discharge was AFB smear positive only in one case. The most common involved vertebral bodies were T12 and L1; however, thoracic and lumbar vertebrae from T12 to L4 were affected. In 4 cases, spondylitis resulted in kyphosis and in two patients; spinal cord compression was detected by imaging techniques. Pott's paraplegia was seen in one patient. All patients were treated according to DOTS strategy, and one underwent surgical drainage of abscess. After termination of initial phase and relative improvement of signs and symptoms, 5 cases were referred for surgical management and subsequently maintenance treatment was continued for 10 months. We suggest that in the endemic countries for tuberculosis, Pott's disease in children must be taken into consideration. Imaging techniques are also valuable means for confirmation of diagnosis