Pott's Disease in a 2-Year-Old Child Treated by Decompression and Anterior-Posterior Instrumented Fusion
Mehmet Nuri Erdem1, Cem Sever2, Mehmet Fatih Korkmaz3
1Department of Orthopaedic Surgery, International Kolan Hospital, Darülaceza Caddesi No. 14 Okmeydanı ,34360 Istanbul, Turkey.
Insights
This study reports a successful surgical approach for spinal tuberculosis in a young child, involving decompression, correction, and 360° fusion. The technique effectively treated paraparesis and kyphotic deformity, enabling early mobilization.
Area of Science:
- Pediatric Orthopedics
- Neurosurgery
- Infectious Diseases
Background:
- Spinal tuberculosis (Pott's disease) can cause severe paraplegia and kyphotic deformity in children.
- Early diagnosis and intervention are crucial for optimal outcomes in pediatric spinal infections.
Purpose of the Study:
- To report a case of a 2-year-old boy with Pott's disease and paraparesis.
- To evaluate the efficacy of a simultaneous anterior-posterior surgical technique for spinal cord decompression, correction, and 360° instrumented fusion.
Main Methods:
- A 2-year-and-9-month-old boy with T5-T7 spinal cord compression due to Pott's disease underwent surgical decompression.
- A three-level corpectomy with anterior structural autogenous fibula and rib graft fusion was performed, followed by posterior pedicle screw instrumentation (T4-T8).
Main Results:
- Postoperatively, the patient showed complete resolution of paraparesis within six months.
- No loss of correction or neurological deficit was observed during the follow-up period.
Conclusions:
- Simultaneous anterior-posterior instrumentation and fusion is a safe and effective strategy for managing severe anterior column destruction in pediatric spinal tuberculosis.
- This approach allows for stable fusion, correction maintenance, and facilitates early patient mobilization.
Abstract:
Introduction. Paraplegia and kyphotic deformity are two major disease-related problems of spinal tuberculosis, especially in the early age disease. In this study a 2-year-old boy who underwent surgical decompression, correction, and 360° instrumented fusion via simultaneous anterior-posterior technique for Pott's disease was reported. Case Report. A 2-year-and-9-month-old boy presented with severe back pain and paraparesis of one-month duration. Thoracic magnetic resonance imaging demonstrated destruction with a large paraspinal abscess involving T5-T6-T7 levels, compressing the spinal cord. The paraspinal abscess drained and three-level corpectomy was performed at T5-6-7 with transthoracic approach. Anterior instrumentation and fusion was performed with structural 1 autogenous fibula and rib graft using screw-rod system. In prone position pedicle screws were inserted at T4 and T8 levels and rods were placed. Six months after surgery, there was no weakness or paraparesis and no correction loss at the end of follow-up period. Discussion. In cases of vertebral osteomyelitis with severe anterior column destruction in the very early child ages the use of anterior structural grafts and instrumentation in combination with posterior instrumentation is safe and effective in maintenance of the correction achieved and allows efficient stabilization and early mobilization.
