The outcome of intervertebral surgery in the treatment of lumbar tuberculosis in children: A case series and long-term follow-up

During the operation of treating lumbar tuberculosis in children, a long-segment or short-segment fixation, and fusion method were usually applied, which would adversely affect the function of normal motion unit. And so, we have been focusing on how we can shorten the range of fixation and fusion using intervertebral surgery. The objective of this retrospective study is to investigate the clinical outcome of intervertebral surgery, in the treatment of lumbar tuberculosis in children. From June 2003 to June 2013, 18 children with lumbar tuberculosis underwent intervertebral surgery, using a combined posterior and anterior approach, in our hospital. The surgical treatments included posterior pedicle screw fixation of affected vertebrae and posterolateral bone grafting, anterior debridement, compression, and strut bone grafting. Indicators such as preoperative and postoperative erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels, neurological function, visual analog scale (VAS) score, kyphotic Cobb angle, complications, healing of lesions, bone graft healing, and recurrence were statistically analyzed. The mean follow-up time was 86.5 months (range, 62–120 months). Three months after the operation, all patients’ ESR and CRP levels decreased to normal, and both the American Spinal Injury Association neurological function scores and VAS scores improved. Successful bone graft healing was achieved, with lesions completely healed at 6 months after surgery, and no recurrence occurred. The preoperative kyphotic was 24.00° ± 13.15° (range −10°–39°), which decreased to −4.61° ± 7.31° (range −19°–10°) postoperative (Z = −4.34, P < .01); the mean deformity correction angle was 28.61° ± 8.43° (range 9°–43°). There was no significant difference between the kyphotic angle measured immediately after surgery at (−4.61° ± 7.31°) and the kyphotic angle measured at 5-year follow-up at (−3.11° ± 7.56°). The mean loss of correction was 1.50° ± 0.90°. Intervertebral surgery using a combined posterior and anterior approach is an effective and safe method for the treatment of lumbar tuberculosis in children. It can also preserve the function of normal motor segments to the maximum extent.