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Pott disease in a 13-month-old: case report
Giac Consigilieri1, Udaya K Kakarla, Nicholas Theodore
1Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
Insights
Pott disease, a spinal tuberculosis, can affect very young children. Surgical intervention in a 13-month-old with paraplegia led to independent ambulation and deformity stabilization.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Neurosurgery
Background:
- Spinal tuberculosis, known as Pott disease, is a common Mycobacterium tuberculosis infection.
- Pott disease most frequently affects the spine, presenting a significant challenge in pediatric cases.
- This case highlights the youngest documented patient with naturally acquired Pott disease in the United States.
Observation:
- A 13-month-old boy presented with paraplegia and diagnosed tuberculosis.
- Imaging revealed a midthoracic kyphotic gibbus deformity causing severe spinal cord compression.
- The patient underwent urgent decompressive laminectomies, corpectomies, strut grafting, and posterior instrumentation.
Findings:
- Post-operatively, the patient showed significant neurological recovery.
- At 18 months follow-up, the child was ambulating independently for short distances.
- The spinal deformity demonstrated no further progression after surgical management.
Implications:
- Pott disease requires consideration even in very young pediatric patients.
- Surgical management is crucial for addressing neurological deficits and spinal instability in pediatric Pott disease.
- Early intervention can lead to favorable outcomes, including functional recovery and deformity control.
Background And Importance:
Tuberculosis (TB) is a common disease worldwide that is caused by Mycobacterium tuberculosis. TB of the spine is the most common site of bony infection and is often referred to as Pott disease. To the best of our knowledge, our case represents the youngest patient with naturally acquired Pott disease in the United States.
Clinical Presentation:
A 13-month-old boy presented with paraplegia and a known diagnosis of TB. His evaluation revealed a kyphotic gibbus deformity in the midthoracic region associated with severe spinal cord compression. The patient underwent urgent decompressive laminectomies, T2-T4 transpedicular corpectomies, placement of an anterior tibial strut graft, and posterior instrumentation with sublaminar wires and a Steinmann pin. At his 18-month follow-up, the patient was ambulating 5 steps at a time independently, and his kyphotic deformity showed no sign of progression.
Conclusion:
Pott disease can occur in very young children and presents a unique challenge when a patient presents with a neurological deficit and unstable deformity requiring surgical intervention.
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