Treatment of Tuberculosis of the Cervical Spine

Abstract

We retrospectively reviewed 15 children (four with paralysis) and 39 adults (10 with paralysis) with tuberculosis of the cervical spine to assess the drug responses, disease arrest, and healing times. Ten children and 13 adults were treated nonoperatively, while anterior débridement was performed in five children (two with paralysis) and anterior radical surgery in 26 adults (10 with paralysis). Triple chemotherapy (isoniazid, rifampin, ethambutol [or pyrazinamide for children]) was given to all patients for 12 months. The tuberculosis began to arrest after 3 months of chemotherapy and healed within 12 months. Spontaneous fusion occurred in all adults but only two of the 10 children. Surgical fusion was achieved within 12 to 16 weeks in adults. In nonoperated patients, an initial kyphosis of 12 degrees progressed to 17 degrees at final followup in the children and an initial kyphosis of 9 degrees progressed to 13 degrees in 13 adults. In operated patients, the initial kyphosis of 13 degrees in adults became 2 degrees at the time of the fusion, while the initial kyphosis of 14 degrees in the five children progressed to 18 degrees. Patients with paraplegia recovered completely within 14 days on average (range, 1-42 days) after treatment. Recovery was gradual in the nonoperative group, while it occurred within 3 days in the operative group.

Spinal tuberculosis in children: Retrospective analysis of 124 patients

“…Children's spine behave differently from the adult spine because of the growth potentiality, remarkable remodeling capacity, and also the difficulty of the accurate assessment of the percentile destruction of the bony vertebral body 15. The pediatric spine grows at an accelerated pace during growth spurts 911131718…”

“…The senior author's hypothesis (MSM) for the low rates of spontaneous intercorporal fusion in children was due to the following factors: Poor bony apposition of the two diseased vertebral bodies by interposition of the thick disc and end plate and ring apophyseal cartilages, and high local production of anti-BMP factor against the increased production of BMP by the infection-related inflammatory cells around the lesions 913…”

“…This has been a controversial issue. Therefore, even after the disease healing in children, regular followup examinations are essential 911–13…”

A large tuberculosis abscess causing spinal cord compression of the cervico-thoracic region in a young child

“…Several reports on tuberculosis of the cervical spine in children have stated principles of management [16,18,19,22,[30][31][32] as follows: (1) obtaining a definitive diagnosis through an appropriate biopsy and culture of the specimen, whenever feasible; (2) institution of appropriate medical management with or without surgical treatment; (3) preservation or restoration of normal neurological function and (4) maintenance of the growing spine stability to prevent subsequent secondary osseous and neurological dysfunction. The combination of raised inflammatory markers, plain X-rays, CT and MRI scans, usually support or is helpful for diagnosis in many cases.…”

“…Image-guided aspiration of the abscess is often a simple and effective choice to reduce the bacterial load and hasten the effectiveness of the medical regime [30,34]. Surgical aspiration is essential as the abscess is often contained within the thick prevertebral cervical fascia and there is no sinus formation by the disease process.…”