Article Figures & Data
Figures
- Figure 1
(A and B) Clinical images of patient 1, showing a marked upper thoracic kyphosis. (C–E) Sagittal, coronal, and axial magnetic resonance imaging (MRI) images of the cervicothoracic spine: bony destruction at the T3 and T4 vertebrae, causing collapse and anterior wedging (sagittal Cobb on MRI of 34°), associated substantial paravertebral soft-tissue extension (an abscess is seen between the T1 and T5 vertebral bodies), and epidural abscess, resulting in spinal canal narrowing and cord compression with no signs of myelopathy. (F) Image of the percutaneous computed tomography-guided biopsy of the involved paravertebral soft tissue.
- Figure 2
(A and B) Postoperative standing whole-spine radiographs of patient 1, showing T2-T6 posterior instrumentation and a T2-T6 sagittal Cobb angle of 31°. (C and D) Clinical images at 6-month evidencing progression of the upper thoracic kyphosis and implant prominence in the proximal area. (E and F) Six-mo standing whole-spine radiographs evidencing an increase in kyphosis and pull-out of the right cranial screw. (G) Computed tomography scan image corroborating a segmental kyphosis of 82.5°, implant failure, and dislodgement of the anterior bone autograft.
- Figure 3
(A and B) Axial and coronal magnetic resonance imaging of the head of patient 1, showing hydrocephalus and tuberculomas. (C and D) Standing whole-spine radiographs of patient 1 taken 3 years after revision surgery, showing T1-T7 posterior instrumentation and acceptable correction of the deformity, with a segmental sagittal Cobb angle of 25°, satisfactory coronal and sagittal balance, and absence of signs of implant failure or nonunion.
- Figure 4
(A and B) Posteroanterior and lateral spine radiograph of patient 2, where signs of a soft-tissue paravertebral abscess can be perceived around the midthoracic spine and angular kyphosis of 38° is present from T5 to T10. (C–E) Magnetic resonance imaging images of the spine evidencing marked kyphosis (48°), T7-T10 prevertebral and intracanal abscesses, and anteroposterior reduction in canal diameter.
- Figure 5
Intraoperative images from patient 2. (A) Right thoracotomy at the apex and rib resection. (B) Pleura bulging and opening, with purulent and caseous material drainage and sample extraction. (C) Visualization of T8 vertebral-body destruction. (D) T8 debridement. (E) Removal of devitalized tissues. (F) Placement of the resected rib as an autograft between T7 and T9 for anterior structural support.
- Figure 6
(A and B) Postoperative standing spine radiographs of patient 2, showing anterior structural bone graft and angular kyphosis correction without posterior instrumentation with a T5-T10 sagittal Cobb angle of 20°. (C and D) Standing whole-spine posteroanterior and lateral radiographs performed at 4 years postoperatively, evidencing a T5-T10 sagittal Cobb angle of 42°, autograft integration, and an adequate sagittal balance.
Tables
Characteristics Patient 1 Patient 2 Age 21 mo 23 mo Symptoms General state deterioration, hypoactivity, poor appetite, neck tilt, and abdominal pain General deterioration and limp Involved spine segments T3-T4 T8 Antitubercular treatment RIF + INH + PZA + EMB Preoperative sagittal Cobb T2-T5 34° T5-T10 48° Surgical procedure Costotransversectomy + debridement + T3 T4 corpectomy + anterior structural rib autograft + T2 T6 PSF Thoracotomy + anterolateral debridement and decompression + T8 corpectomy + anterior structural rib autograft Postoperative complications Meningitis (VPD), anti-TB hepatotoxicity, progressive kyphosis, and screw pull-out Kyphosis, without progression after the first year Reintervention 3-column OT + anterior fibular allograft + posterior T1-T7 fixation None Follow-up 36 mo 48 mo AFB, acid-fast bacilli; EMB, ethambutol; INH, isoniazid; OT, osteotomy; PSF, posterior spinal fusion; PZA, pyrazinamide;RIF, rifampicin; TB, tuberculosis; VPD, ventriculoperitoneal derivation.
- Table 2
Summary of the cases of surgically treated spinal TB in patients under 2 years of age reported in the literature.
Literature Age (mo)/Sex Location Symptoms Time From Onset to Diagnosis Surgical Treatment Complications Microbiology Histopathlogy FU (mo) Tufan et al19 8/M T12-L1 Hump on his back and difficulty sitting 1 mo Anterolateral debridement + abscess drainage + ASF with fibular allograft Right psoas abscess. Kyphosis progression - Caseous necrosis,
AFB+24 Kıymaz et al20 12/F T8-T9 Bulge on her back and leg weakness 3 mo Anterior T8-T9 corpectomy + decompression +
ASF with fibular allograftNone. No neurological recovery after decompressive surgery + Granulomatous inflammatory reaction,
AFB+NR Lee et al21 13/M C4-T1 Right leg and arm weakness 1 mo Decompressive laminectomy + abscess drainage Airway obstruction due to abscess (×3 surgical drainage) + Caseous necrosis with granulomatous formation, AFB+ 24 Consigilieri et al22 13/M T3-T5 Loss of ambulation 1 mo Decompressive laminectomy + posterior T2-T4 corpectomies + abscess drainage + anterior fibular and posterior structural graft + C7 T7 sublaminar wiring None NR NR 26 Tian et al23 24/M C5-C6 Gait difficulty and neck pain 2 mo Anterior cervical debridement without fusion None + Granuloma AFB+ 72 Cavus et al24 24/F T2-T4 Motor deficit (leg) NR Abscess drainage + decompression + C7 T7 PSF + posterior allograft None NR Necrotizing granulomatous inflammation 12 Sangondimath et al25 19/M T4-T7 Painful kyphosis and leg weakness 1 mo Posterior T4-T7 VCR + anterior cage + T1 T9 posterior stabilization Progressive deformity (revision surgery: spread to T10) + NR 12 Current report 2020 21/M T3-T4 General deterioration, neck tilt, and abdominal pain 3 wk Posterolateral T3-T4 corpectomies + debridement + ASF with rib autograft + T2 T6 PSF TB meningitis (VPD), drug hepatotoxicity, and PJK (revision surgery: apical 3-column OT) + Chronic granulomatous inflammation, AFB+ 36 23/M T8 General deterioration and limp 1.5 mo Anterolateral T8 corpectomy + debridement + decompression + ASF with rib graft Kyphosis, nonprogressive after the first year + Necrotizing epithelioid osteomyelitis, AFB+ 48 AFB, acid-fast bacilli; ASF, anterior spinal fusion; F, female; FU, follow-up; M, male; NR, not registered; OT, osteotomy; PJK, proximal junction kyphosis; PSF, posterior spinal fusion;TB, tuberculosis; VCR, vertebral column resection; VPD, ventriculoperitoneal derivation.;
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