The Journal of Spinal Surgery

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VOLUME 5 , ISSUE 1 ( January-March, 2018 ) > List of Articles

Original Article

Conservatively Treated Spinal Tuberculosis in Children:Ambulatory Chemotherapy

Myung-Sang Moon

Keywords : Chemotherapy, Children, Kyphosis, Spine, Tuberculosis

Citation Information : Moon M. Conservatively Treated Spinal Tuberculosis in Children:Ambulatory Chemotherapy. J Spinal Surg 2018; 5 (1):10-17.

DOI: 10.5005/jp-journals-10039-1162

License: CC BY-NC 4.0

Published Online: 01-04-2019

Copyright Statement:  Copyright © 2018; The Author(s).


Abstract

Introduction: To assess the chronological changes of the disease-related kyphosis after chemotherapy alone, and secondly to clarify the role of growth cartilage in the healed lesion on kyphosis change. Materials and methods: A total of 101 children with spinal tuberculosis in various stages of disease processes, aged 2 to 15 years, were the subject materials. They were treated with two different chemotherapy formulas; before 1975, 18 months of triple chemotherapy [isoniazid (INH), paraaminosalicylic acid (PAS), and Streptomycin], and from 1976, 12 months of triple chemotherapy (INH, rifampicin, ethambutol, or pyrazinamide). By utilizing the images, the effects of the remaining growth plate cartilage on chronological changes of kyphosis after the initiation of chemotherapy were analyzed. The first assessment at postchemotherapy was at 1 year and at the final discharge time from the follow-up. Results: Complete disk destruction at the initial examination was observed in 2 (5.0%) out of 40 cervical spine, 8 (26.7%) out of 30 dorsal spine, and 6 (19.4%) out of 31 lumbosacral spine. In those cases, kyphosis developed inevitably. In the remainders, the disks were partially preserved or remained intact. Among 101 children, initial kyphosis was maintained in 20 (19.8%), while kyphosis decreased in 14 (13.7%) children, and increased in 67 (66.3%) children with nonrecoverably damaged growth plate. Conclusion: It was possible to predict the fate of the kyphosis at the time of initial treatment, but its predictive accuracy was low. Therefore, finally, it is recommended to be done at the end of chemotherapy. In children, the kyphotic deformity assessment should be continued till the maturity


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  1. Schulitz KP, Kothe R, Leong JC, Wehling P. Growth changes of solidly fused kyphotic bloc after surgery for tuberculosis. Comparison of four procedures. Spine (Phila Pa 1976) 1997 May;22(10):1150-1155.
  2. Moon MS, Kim I, Woo YK, Park YO. Conservative treatment of tuberculosis of the thoracic and lumbar spine in adults and children. Int Orthop 1987;11(4):315-322.
  3. Moon MS. Tuberculosis of spine. Controversies and a new challenge. Spine 1997 Aug;22(15):1791-1797.
  4. A 10-year assessment of controlled trials of inpatient and outpatient treatment and of plaster-of-Paris jackets for tuberculosis of the spine in children on standard chemotherapy. Studies in Masan and Pusan, Korea. Ninth report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg Br 1985 Jan;67(1):103-110.
  5. Moon MS, Moon YW, Moon JL, Kim SS, Sun DH. Conservative treatment of tuberculosis of the lumbar and lumbosacral spine. Clin Orthop Relat Res 2002 May;(398):46-49.
  6. Moon MS, Moon JL, Kim SS, Moon YW. Treatment of tuberculosis of the cervical spine: operative versus nonoperative. Clin Orthop Relat Res 2007 Jul;460:67-77.
  7. Moon MS, Lee BJ, Kim SS, Lim SF. Evolution of management of spinal deformity: controversial issues and current concept review. J Spinal Surg 2010;2:295-305.
  8. Moon MS, Kim JM. The effect of mechanical forces on vertebral growth. J Western Pacif Orthop Assoc 1974;11:1-16.
  9. Rajasekaran S. The problem of deformity in spinal tuberculosis. Clin Orthop Relat Res 2002 May;(398):85-92.
  10. Rajasekaran S. The natural history of post-tubercular kyphosis in children. Radiological signs which predict late increase in deformity. J Bone Joint Surg Br 2001 Sep;83(7):954-962.
  11. Moon MS, Kim SS, Lee BJ, Moon JL. Spinal tuberculosis in children: retrospective analysis of 124 patients. Indian J Orthop 2012 Mar-Apr;46(2):150-158.
  12. Bailey J, Gabriel M, Hodgson AR, Shin JS. Tuberculosis of the spine in children. Operative findings and results in one hundred consecutive patients treated by removal of the lesion and anterior grafting. J Bone Joint Surg Am 1972 Dec;54(8):1633-1657.
  13. Five-year assessments of controlled trials of ambulatory treatment, debridement and anterior spinal fusion in the management of tuberculosis of the spine. Studies in Bulawayo (Rhodesia) and in Hong Kong. Sixth report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg Br 1978 May;60-B(2):163-177.
  14. Upadhyay SS, Saji MJ, Sell P, Sell B, Hsu LC. Spinal deformity after childhood surgery for tuberculosis of the spine. A comparison of radical surgery and debridement. J Bone Joint Surg Br 1994 Jan;76(1):91-98.
  15. Tuli SM. Tuberculosis of the skeletal system: bones, joints, spine and bursal sheaths, 3rd ed. New Delhi: Jaypee Brothers Publishers; 2004.
  16. Jain AK, Aggarwal PK, Arora A, Singh S. Behaviour of the kyphotic angle in spinal tuberculosis. Internat Orthop (SICOT) 2004 Apr;28:110-114.
  17. Masini M, Maranho V. Experimental determination of the effect of progressive sharp-angle spinal deformity on the spinal cord. Eur Spine J 1997;6(2):89-92.
  18. Moon MS, Kim SS, Sihn JC. Tuberculous kyphosis—evolving concepts in prevention and treatment. J Musculoskeletal Res 2015 Sep;18(3):1-14.
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