Tuberculosis of the spine in children – does drug resistance affect surgical outcomes?

Pediatric paraparesis: Radiological challenges in multidrug-resistant tuberculous spondylitis based on experience in Indonesia

“…The spine is frequently affected by TB in the skeletal system, which typically occurs as a secondary infection, when the bacteria spread hematogenously from the primary site of infection or through the Batson's venous plexus [8] , [9] , [10] . In children who are still growing, the disease can have extremely detrimental consequences, and these effects can continue to worsen even after the infection is brought under control [11] . The clinical onset is gradual and slow, with a prolonged duration and a resulting delayed presentation, which often consist of chronic back pain, tenderness, limited mobility, and non-specific symptoms [ 5 , 9 , 10 ].…”

“…The treatment necessitates a combination of ATT and careful utilization of surgery [ 8 , 11 ]. Surgery is typically considered for sudden or severe neurological deficits, progressive or unresponsive impairment despite non-surgical treatment, noticeable deformities, or involvement of both anterior, and posterior spine columns [8] .…”

“…Surgery is typically considered for sudden or severe neurological deficits, progressive or unresponsive impairment despite non-surgical treatment, noticeable deformities, or involvement of both anterior, and posterior spine columns [8] . MDR-TB complicates the treatment of tuberculous spondylitis, affecting 11.7%-30.7% of culture-positive cases, because it may lead to increased surgical complications [11] . Due to the extent of the disease, presence of a neurological deficit, a large paravertebral abscess, and a deformity that could lead to future disability, the patient was not only treated with ATT, but also underwent surgical intervention.…”

Tumors and infections of the growing spine

“…107 Generally, there are two main groups of surgical procedures: (1) debridement with the release of neural structures, and (2) debridement and spinal stabilization (with bone grafts and implants). 109,[111][112][113] A third kind of surgery concerns progressive kyphotic deformities in the healed phase. 114 These procedures are difficult to perform, with high risk of complications.…”