Analysis of the Therapeutic Effects of Staged Posterior–Anterior Combined Surgery for Cervicothoracic Segmental Tuberculosis with Kyphosis in Pediatric Patients

Abstract

Objective The present study aimed to investigate the surgical efficacy of staged posterior–anterior combined surgery for the treatment of cervicothoracic segmental tuberculosis (TB) with kyphosis in pediatric patients. Methods The clinical data of 15 pediatric patients admitted to our hospital from January 2010 to December 2017 who underwent staged posterior–anterior combined surgery for cervicothoracic segmental TB with kyphosis were collected. A posterior median incision was made for patients after general anesthesia. Autologous bone particles or allogeneic bone particles were taken, trimmed, and placed in the articular eminence of the diseased vertebral body. Fifteen pediatric patients underwent second-stage lesion removal using the anterior approach. The left sternocleidomastoid muscle was selected as the medial oblique incision approach. The abscess and caseous necrotic material were removed and sent for pathological examination. The sagittal and coronal parameters (including the local Cobb angle, the sagittal vertical axis [SVA], and the coronal balance distance [CBD]) were measured at three time points: preoperatively, postoperatively, and at the final follow-up. The American Spinal Injury Association’s spinal-cord injury classification, the Japanese Orthopaedic Association’s (JOA) cervical spine function score, the neck disability index (NDI), and the visual analogue score (VAS) for cervicothoracic segment pain were adopted for the assessment of functional improvement and quality of life. Results All 15 pediatric patients completed the surgery successfully, with an operation duration of 3.56 ± 0.68 h, an intraoperative hemorrhage of 289.7 ± 84.3 mL, an average fixation of 7.3 ± 1.8 segments, and a follow-up duration of 28.1 ± 9.7 months. The preoperative and postoperative sagittal local Cobb angle was 67.06 ± 17.54° vs 19.48 ± 2.32° (P < 0.01), the SVA was 35.19 ± 10.69 mm vs 7.67 ± 1.40 mm (P < 0.01), and CBD was 22.58 ± 7.59 mm vs 8.99 ± 1.25 mm (P < 0.01). The levels of the postoperative erythrocyte sedimentation rate and C-reactive protein were significantly lower in all patients. The preoperative and postoperative JOA scores were 8.93 ± 3.51 and 14.67 ± 1.34, respectively, the preoperative and postoperative VAS was 7.40 ± 1.35 and 2.67 ± 0.62, respectively, and the preoperative and postoperative NDI was 32.67 ± 4.83 and 13.73 ± 2.08, respectively. There were statistically significant differences in the above indicators before and after surgery (P < 0.05). Conclusion In the surgical treatment of cervicothoracic TB with kyphosis in pediatric patients, staged posterior–anterior combined surgery significantly corrects deformity, achieves the safe and effective neurological decompression of the spinal cord, and obtains good neurological recovery and bone-graft fusion according to the extent of the involved segments of kyphosis, the characteristics of the lesion, and the degree of neurospinal injury. ...

The Incidence, Changes and Treatments of Cervical Deformity After Infection and Inflammation

“…At the same time, there was no significant difference in the C2-7 sagittal vertical axis (SVA) (16.10 ± 7.74 mm vs. 16.18 ± 13.22 mm) between them. 49 The whole sagittal alignment changes in patients with CSTB kyphosis who underwent staged combined posterioranterior surgery were reported by Luan et al 50 : The SVA (35.19 ± 10.69 mm) and coronal balance distance (22.58 ± 7.59 mm) was greater than the normal values, indicating a coronal and sagittal imbalance. Surgery can improve the cervical spine sagittal alignment; the C0-2, C2-7, and local Cobb angles, T1 slope, C2-7 SVA, and CGH-C7 SVA were corrected remarkably after surgery.…”

“…Indications for surgery of patients with CSTB include progressive neurological worsening, significant static neurological deficits, kyphotic deformity, spinal instability, bowel bladder involvement, no response to chemotherapy, and large paraspinal abscess. 24,36,38,50,61 Regarding atlantoaxial TB, atlantoaxial and occipitocervical fusion are the most preferred globally. 62 If atlantoaxial TB is irreducible or rotatory, posterior distraction with stabilization or a combined anteroposterior approach should be undertaken.…”

Predicting Surgical Site Infection Risk after Spinal Tuberculosis Surgery: Development and Validation of a Nomogram

“…The spine tuberculosis surgery methods usually include an anterolateral approach, a posterior approach, and a combined anterior and posterior approach [ 6 , 15 ]. The common post-operative surgical site complications include surgical site infection, delayed surgical site healing, and sinus tract [ 7–10 , 15 ]. Only a few reports are available in the literature on the risk factors of surgical site infection after spinal tuberculosis surgery.…”

Diagnosis and Treatment of Skipped Multifocal Spinal Tuberculosis Lesions

“…This procedure primarily comprises anterior debridement and posterior fixation in two parts, which can be performed in one step or separately. 128,129 In terms of therapeutic effect, complete anterior decompression with firm posterior fixation can eradicate tuberculosis and maintain enduring spinal stability. Shi et al 115 reported on a group of patients with noncontiguous spinal tuberculosis treated by the combined anteriorposterior approach, and the prognosis was substantially improved.…”

“…The combined anterior–posterior approach is also a quite mature surgical technique that can compensate for the shortcomings in treatment outcomes observed with the anterior or posterior approach alone. This procedure primarily comprises anterior debridement and posterior fixation in two parts, which can be performed in one step or separately 128,129 . In terms of therapeutic effect, complete anterior decompression with firm posterior fixation can eradicate tuberculosis and maintain enduring spinal stability.…”