Analysis of the Therapeutic Effects of Staged Posterior–Anterior Combined Surgery for Cervicothoracic Segmental Tuberculosis with Kyphosis in Pediatric Patients

Figures & data

Table 1 The General Characteristics and Follow-Up Data in 15 Cases with Cervicothoracic Tuberculosis and Kyphosis

Cases	Age/Gender	Follow-Up Time (Months)	ASIA Grade			Erythrocyte Sedimentation Rate(mm/h)		C-Reactive Protein(mg/L)
			Pre-Operative	Postoperative	Final Follow- Up Visit	Pre-Operative	3 Months Postoperative	Pre-Operative	3 Months Postoperative
1	3/Female	23	C	E	E	45	4	22.88	6.37
2	12/Male	34	C	C	C	43	3	13.58	4.69
3	8/Male	35	B	D	D	53	11	24.56	9.32
4	12Female	29	C	D	D	46	6	14.09	7.78
5	6/Male	40	C	E	E	40	18	47.70	11.38
6	2/Male	29	D	D	E	32	4	10.10	7.65
7	8/Female	39	B	C	D	28	3	11.05	6.79
8	3/Female	44	D	E	E	18	7	22.96	7.70
9	12Female	25	B	D	E	62	4	22.50	10.32
10	4/Male	15	C	D	E	60	23	9.25	7.31
11	4/Female	24	B	C	D	30	3	17.40	10.13
12	9/Female	14	D	E	E	26	8	65.90	15.76
13	4/Male	12	C	D	E	34	6	27.45	9.08
14	9/Female	26	D	E	E	43	16	27.36	9.44
15	6/Female	33	D	E	E	42	9	23.35	8.67

Figure 1 A female patient of 7 years old with C7-T9 vertebral tuberculosis and kyphosis. One-stage posterior approach internal fixation orthopedics was conducted followed by two-stage anterior approach lesion removal with additional bone grafting. (A and B) The preoperative whole spine frontal and lateral x-ray showed cervicothoracic segmental kyphosis, and obvious C7-T9 localized lateral kyphosis. (C) The preoperative MRI indicated the destruction of the C7~T9 vertebral body and intervertebral disc, a small amount of abscess formation in the paravertebral area, and a change in the intervertebral disc signal. (D and E) The preoperative CT and sagittal 3D reconstruction suggested multiple bone destruction at C7-T9, with some of the bone edges becoming hyperplastic and sharp. (F and G) The whole spine frontal and lateral x-ray after the staged posterior-anterior combined surgery showed a good position of the internal fixation and a good sequence of cervicothoracic vertebrae. (H and I) The whole spine frontal and lateral x-ray one year after surgery showed good internal fixation and complete osseous fusion.

Figure 2 A female patient of 3 years old with C4–T4 vertebral tuberculosis and kyphosis. One-stage posterior approach internal fixation orthopedics was conducted followed by two-stage anterior approach lesion removal with additional bone grafting. (A and B) The preoperative whole spine frontal and lateral x-ray showed obvious C4–T4 kyphosis. (C) The preoperative MRI showed destruction of C4~T4 vertebral body and intervertebral disc, with paravertebral abscess formation and change in the intervertebral disc signal. (D and E) The preoperative CT and sagittal 3D reco nstruction suggested C4-T4 multiple arch bone destruction with C6 vertebral body collapse. (F and G) The whole spine frontal and lateral x-ray after the staged posterior-anterior combined surgery showed a good position of the internal fixation. (H and I) The whole spine frontal and lateral x-ray six year after surgery showed good internal fixation and complete osseous fusion.

Table 2 Results of Imaging Measurements Before and After Surgery and at the Last Follow-Up in 15 Pediatric Patients

	Preoperative	Postoperative	Final Follow-Up Visit	Statistical Values
				Pre-Op vs Post-Op	Post-Op vs Final Follow-Up
The coronal balance distance(mm)	22.58±7.59	8.99±1.25	7.91±0.61	t=6.642,P<0.01	t=2.635,P=0.02
The kyphosis Cobb angle(°)	67.06±17.54	19.48±2.32	18.63±2.77	t=10.863,P<0.01	t=2.066,P=0.058
The sagittal vertical axis(mm)	35.19±10.69	7.67±1.40	6.97±1.50	t=10.227,P<0.01	t=4.740,P<0.01

Table 3 The Results of JOA Score, VAS, and NDI Before and After Surgery and at the Last Follow-Up in 15 Pediatric Patients

	Preoperative	Postoperative	Final Follow-Up Visit	Statistical Values
				Pre-Op vs Post-Op	Pre-Op vs Final Follow-Up
JOA Score	8.93±3.51	14.67±1.34	15.80±0.94	t=7.206, P<0.01	t=3.371, P=0.05
VAS Score	7.40±1.35	2.67±0.62	1.80±0.56	t=14.992, P<0.01	t=5.245, P<0.01
The neck disability index(NDI)	32.67±4.83	13.73±2.08	9.60±1.81	t=16.369, P<0.01	t=16.163, P<0.01