Anterior and posterior fusion for children with tuberculosis of the spine.
The authors reviewed the use of chemotherapy and anterior/posterior spinal fusion without instrumentation to treat children with extensive spinal tuberculosis and kyphosis. Six children underwent anterior and posterior spinal fusion. All of the patients were followed until after maturity, except for 1 child who died of pulmonary tuberculosis 4 months after surgery and thus was excluded from the study. Preoperative kyphotic deformity averaged 100 degrees (range, 75 degrees-130 degrees). The average age at the time of surgery was 7.5 years (range, 4.7-10 years). Spinal involvement extended from 2 to 10 vertebral bodies (average, 7.6) and was limited to the thoracic region from T-2 to T-12. Preoperative, postoperative, and followup anterior/posterior and lateral standing radiographs were obtained. The kyphotic angle was measured from the lateral view. The surgical correction of preoperative kyphosis averaged 28.6 degrees (range, 20 degrees-45 degrees). One patient underwent repeat anterior fusion at 9 months for graft failure. At the time of followup, all grafts had fused and all patients were without pain. The average duration of followup was 12.8 years (range, 9.5-14.5 years). Complications secondary to chronic chemotherapy occurred in 2 children. Long-term followup revealed solid fusion, improvement of the kyphotic deformity, and good functional outcome in all 5 patients.