1. One-Year Multidrug Treatment for Tuberculosis of the Cervical Spine in Children
- Author
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Anil Agarwal, Kumar Shashi Kant, Anubrat Kumar, and Abbas Shaharyar
- Subjects
Orthopedic surgery ,RD701-811 - Abstract
Purpose. To review the clinical and radiological features and treatment outcome in 22 children who underwent one-year antitubercular multidrug treatment for tuberculosis of the cervical spine. Methods. Records of 13 boys and 9 girls aged 2 to 12 (mean, 9.1) years who underwent one-year antitubercular multidrug treatment for tuberculosis of the cervical spine were reviewed. Tuberculosis involved the atlantoaxial region (C1–C2) in 7 patients, mid-cervical region (C3–C7) in 8, cervicodorsal region (C6–T3) in 3, contiguous multilevels in 2, and non-contiguous multifocal areas in 2. The mean number of vertebrae involved was 2.8 (range, 1–8). The mean symptom duration was 2.5 (range, 0.25–6) months. Three patients had neurological deficits. Antitubercular multidrug treatment included an intensive phase for 2 months and a continuation phase for 10 months, using isoniazid, rifampicin, pyrazinamide, and ethambutol. Results. At a mean of 2.25 (range, 0.5–5) years after treatment, no patient had recurrence, pain, or dynamic instability. Full range of movement was achieved after a mean of 2.7 (range, 1–4) months in all but 3 patients. In the 3 patients with neurological deficits, recovery was achieved after a mean of 8 (range, 5–14) weeks. Soft tissue swelling resolved after a mean of 11 (range, 8–12) weeks. Remineralisation of vertebrae occurred after a mean of 2 (range, 2–6) months. Spontaneous vertebral fusion occurred in only 6 of 22 patients after a mean of 36 (range, 18–72) months. Three patients developed kyphotic deformity. Conclusion. Antitubercular multidrug treatment is a viable option for children with tuberculosis of the cervical spine, even in the presence of neurological deficits. Development of deformity is not common; interbody fusion is usually delayed. Patients with contiguous multilevel involvement with vertebral erosion or collapse should be closely monitored for development of late deformity.
- Published
- 2015
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