Pott's disease in children - abstract

ABSTRACT

The authors present their experience with the treatment of tuberculosis of the spine in children during the past ten years in Haiti. Two hundred and fifty-three patients under the age of fifteen have been treated. Initial treatment has consisted of bed rest and chemotherapy. Isoniazid and para-aminosalicylic acid in appropriate dose have been continued for two years. Most were begun on streptomycin initially, but this was usually discontinued after two to three months. One hundred and ninety patients had a surgical fusion. Sixteen of these were re-explored for pseudoarthrosis. One patient died postoperatively and one has a persistent pseudarthrosis; the remainder showed solid fusion within four months on a continued postoperative program of bed rest and chemotherapy. Ninety-eight patients had neurological involvment ranging from slight spasticity to total paraplegia. None had any emergency surgery and ninety-two patients recovered with no serious residuum. Of the remaining six all were able to walk although three who has long-standing paraplegia still required crutches anbd braces for ambulation. No laminectomies were done. Many children, even with several vertebrae involved, will not get well on a program of supportive, recumbent therapy with chemotherapy. The authors' indications for surgical fusion now are (1) failure to heal properly on conservative therapy, (2) increasing deformity during treatment, (3) lumbar destruction likely to impair stability, (4) to ensure immobilization when the follow-up treatment is doubtful. (Au)