Smith–Petersen osteotomy combined with anterior debridement and allografting for active thoracic and lumbar spinal tuberculosis with kyphotic deformity in young children: A prospective study and literature review

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Abstract

The purpose of this study is to determine the efficacy and safety of Smith–Petersen osteotomy combined with anterior debridement and allogenic strut bone grafting for the treatment of active thoracic and lumbar spinal tuberculosis with kyphotic deformity in young children.

Spinal tuberculosis is more destructive in young children and often causes severe kyphosis and paraplegia. Despite much progress has been made, surgical treatment is still controversial and technically challenging.

From October 2010 to August 2014, 25 children (11 males, 14 females; aged under 6 years) with active thoracic and lumbar spinal tuberculosis treated by Smith–Petersen osteotomy combined with anterior debridement and allogenic strut bone grafting were enrolled in this study. The pre- and postoperative data, follow-up medical records, imaging studies, and laboratory data were collected prospectively. Clinical outcomes were evaluated on the basis of kyphotic angle and the Frankel motor score system. The changes in C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), clinical symptoms, and complications were investigated. Graft fusion was evaluated using the Bridwell grading criteria.

The mean age was 3.5 ± 1.76 years (range, 1–6 years). All patients were followed up for 25 to 45 months (average, 34.3 ± 5.86 months). The average kyphotic angle was changed significantly from a preoperative value of 44.1 ± 10.8° to a postoperative value of 11.4 ± 3.9°, with an average correction rate of 74% (P < .05). According to the Frankle motor score system, neurological deficits were significantly improved by the time of the last follow-up, with an average improvement of 1.7 grades (P < .05). There were 2 cases of rod breakage and 1 case of graft bone displacement. No patients experienced a recurrence of tuberculosis. According to Bridwell criteria, the degree of fusion was grade I in 23 patients and grade II in 2 patients with a fusion rate of 92%.

For young children with active thoracic and lumbar spinal tuberculosis, Smith–Petersen osteotomy combined with anterior debridement and allogenic strut bone grafting is a safe and simple procedure to achieve sufficient kyphosis correction, good neurological recovery, and reliable anterior column reconstruction.

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