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Published on: October 25, 2024
Management of cervical spine tuberculosis in pediatrics: a systematic review
Vega Pangaribuan1,2, Muhammad Arifin Parenrengi3,4, Wihasto Suryaningtyas1,2
1Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia.
Insights
Pediatric cervical spine tuberculosis (CST) management varies by location. Surgery combined with medication improves outcomes, but tailored strategies and further research are needed for pediatric CST.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Spinal Surgery
Background:
- Cervical spine tuberculosis (CST) is a rare but serious condition in children.
- Understanding clinical presentation and treatment outcomes is crucial for effective management.
Purpose of the Study:
- To systematically review the literature on pediatric CST.
- Evaluate clinical presentation, management, and outcomes based on anatomical location.
- Compare conservative vs. surgical treatment efficacy.
Main Methods:
- Systematic literature search for pediatric CST studies over the past 20 years.
- Adherence to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P).
- Inclusion of 9 studies with 185 pediatric patients.
Main Results:
- Common symptoms varied by location: neck pain (CVJ), neck rigidity (subaxial), deformity (cervicothoracic).
- Surgery yielded significant neurological improvement (94.1%).
- Conservative treatment was effective for CVJ stability, but subaxial/cervicothoracic groups showed potential for progressive deformity.
Conclusions:
- Combined surgical and antitubercular treatment improves neurological function and deformities in pediatric CST.
- Individualized surgical strategies are essential.
- Further comparative studies are required to strengthen evidence for pediatric CST treatment.
Aim:
To systematically review the literature on the clinical presentation and management of pediatric cervical spine tuberculosis (CST) and evaluate the outcomes of conservative or surgical treatment based on anatomical location (craniovertebral junction [CVJ], subaxial, and cervicothoracic junction).
Method:
We searched for studies reporting the management for pediatric CST published over the past 20 years. The search flow followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P) criteria.
Results:
This review included a total of 9 studies with a total of 185 patients. The average age at diagnosis was 6.68 ± 3.9 years. The most common presenting symptoms in each anatomical group were as follows: the CVJ group presented with neck pain (90.3%), the subaxial group with neck rigidity (72%), and the cervicothoracic junction group with deformity (84.4%). Most patients in the surgical group showed neurological improvement after surgery (81/86 patients [94.1%]) Improvement in deformity was reported in subaxial and cervicothoracic junction groups managed with combined approach. The extent of surgical debridement in pediatric CST remains debatable. Conservative treatment in the CVJ group provided stability and complete range of motion; whereas, in the subaxial and cervicothoracic junction groups, there have been reports of progressive deformity and limited neck mobility.
Conclusion:
Surgical treatment in combination with appropriate antitubercular medication could improve neurological function and/or deformities. The surgical strategy should be tailored to each patient's condition. Larger comparison studies are needed to provide stronger evidence for the treatment of pediatric CST.
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