Asian Spine Journal

  • 제12권6호
  • /
  • Pages.1069-1077
  • /
  • 2018
  • /
  • 1976-1902(pISSN)
  • /
  • 1976-7846(eISSN)
대한척추외과학회 (Korean Society of Spine Surgery)
권호 표지
DOI QR코드

DOI QR Code

Most Reliable Time in Predicting Residual Kyphosis and Stability: Pediatric Spinal Tuberculosis

  • Moon, Myung-Sang (Department of Orthopedic Surgery and Traumatology, Cheju Halla General Hospital) ;
  • Kim, Sang-Jae (Department of Orthopedic Surgery and Traumatology, Cheju Halla General Hospital) ;
  • Kim, Min-Su (Department of Orthopedic Surgery and Traumatology, Cheju Halla General Hospital) ;
  • Kim, Dong-Suk (Department of Orthopedic Surgery and Traumatology, Cheju Halla General Hospital)
  • 투고 : 2017.12.06
  • 심사 : 2018.04.17
  • 발행 : 2018.12.31
⟨ 이전 논문 다음 논문 ⟩

초록

Study Design: A case study. Purpose: To assess the chronological changes of the disease-related kyphosis after chemotherapy alone, secondly to clarify the role of growth cartilage in the healed lesion on kyphosis change, and to define the accurate prediction time in assessing residual kyphosis. Overview of Literature: None of the previous papers up to now dealt with the residual kyphosis, stability and remodeling processes of the affected segments. Methods: One hundred and one spinal tuberculosis children with various stages of disease processes, age 2 to 15 years, were the subject materials, between 1971 to 2010. They were treated with two different chemotherapy formula: before 1975, 18 months of triple chemotherapy (isoniazid [INH], para-aminosalicylic acid, streptomycin); and since 1976, 12 months triple chemotherapy (INH, rifampicin, ethambutol, or pyrazinamide). The first assessment at post-chemotherapy one year and at the final discharge time from the follow-up (36 months at minimum and 20 years at maximum) were analyzed by utilizing the images effect of the remaining growth plate cartilage on chronological changes of kyphosis after initiation of chemotherapy. Results: Complete disc destruction at the initial examination were observed in two (5.0%) out of 40 cervical spine, eight (26.7%) out of 30 dorsal spine, and six (19.4%) out of 31 lumbosacral spine. In all those cases residual kyphosis developed inevitably. In the remainders the discs were partially preserved or remained intact. Among 101 children kyphosis was maintained without change in 20 (19.8%), while kyphosis decreased in 14 children (13.7%), and increased in 67 children (66.3%) with non-recoverably damaged growth plate, respectively. Conclusions: It could tentatively be possible to predict the deformity progress or non-progress and spontaneous correction at the time of initial treatment, but it predictive accuracy was low. Therefore, assessment of the trend of kyphotic change is recommended at the end of chemotherapy. In children with progressive curve change, the deformity assessment should be continued till the maturity.

키워드

참고문헌

  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;22:1150-5. https://doi.org/10.1097/00007632-199705150-00016
  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;11:315-22. https://doi.org/10.1007/BF00271307
  3. Moon MS. Tuberculosis of the spine: controversies and a new challenge. Spine (Phila Pa 1976) 1997;22:1791-7. https://doi.org/10.1097/00007632-199708010-00022
  4. Medical Research Council Working Party on Tuberculosis of the Spine. 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;67:103-10.
  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;(398):40-9.
  6. Moon MS, Moon JL, Kim SS, Moon YW. Treatment of tuberculosis of the cervical spine: operative versus nonoperative. Clin Orthop Relat Res 2007;460:67-77.
  7. Moon MS, Lee BJ, Kim SS, Lin JF. 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 West Pac Orthop Assoc 1974;11:1-16.
  9. Rajasekaran S. The problem of deformity in spinal tuberculosis. Clin Orthop Relat Res 2002;(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;83:954-62.
  11. 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;60-B:163-77. https://doi.org/10.1302/0301-620X.60B2.350883
  12. 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;76:91-8.
  13. Tuli SM. Tuberculosis of the skeletal system: bones, joints, spine and bursal sheaths. 3rd ed. New Delli: Jaypee Brothers Medical Publishers; 2004.
  14. Jain AK, Aggarwal PK, Arora A, Singh S. Behaviour of the kyphotic angle in spinal tuberculosis. Int Orthop 2004;28:110-4. https://doi.org/10.1007/s00264-003-0516-z
  15. Masini M, Maranhao V. Experimental determination of the effect of progressive sharp-angle spinal deformity on the spinal cord. Eur Spine J 1997;6:89-92. https://doi.org/10.1007/BF01358738
  16. Bailey HL, 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;54:1633-57. https://doi.org/10.2106/00004623-197254080-00004
  17. Moon MS, Kim SS, Lee BJ, Moon JL. Spinal tuberculosis in children: retrospective analysis of 124 patients. Indian J Orthop 2012;46:150-8. https://doi.org/10.4103/0019-5413.93676
  18. Moon MS, Kim SS, Sihn JC. Tuberculous kyphosis: evolving concepts in prevention and treatment. J Musculoskelet Res 2015;18:1530002. https://doi.org/10.1142/S0218957715300021