Posterior instrumentation combined with anterior debridement and reconstruction using allogenic strut bone for the treatment of children with multilevel lumbar spinal tuberculosis: minimum 5-year follow-up

OBJECTIVES: To evaluate the clinical outcomes of one-stage posterior instrumentation combined with anterior debridement and reconstruction using allogenic strut bone for the surgical treatment of multilevel lumbar spinal tuberculosis in children younger than 10 years of age with at least 5 years of follow-up. METHODS: A total of 16 children with multilevel lumbar spinal tuberculosis who underwent one-stage posterior instrumentation combined with anterior debridement and reconstruction using allogenic strut bone were enrolled from January 2003 to January 2017. Among them, 6 were females and 10 were males with an average age of 6.9 ± 2.2 years (range 3–10 years). Patients’ clinical outcomes, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), kyphosis angle, and neurologic function, were assessed before and after surgery. P < 0.05 was considered statistically significant. RESULTS: The average follow-up was 7.8 ± 2.4 years. CRP and ESR of all patients returned to the normal range within 1 year. Compared with preoperative neurological deficits, postoperative and final follow-up neurological deficits improved significantly by grades 0.9 and 1.6, respectively. No instrumentation failure occurred, and all patients achieved solid bone fusion. The preoperative kyphosis angle was 29.9 ± 8.1°, which decreased significantly to 5.9 ± 2.6° postoperatively. There was a mild loss (2.5°) and the kyphosis angle was 8.4 ± 2.9° at final follow-up, with an overall correction rate of 71.3%. CONCLUSION: One-stage posterior instrumentation combined with anterior debridement and reconstruction using allogenic strut bone is a safe and effective procedure for children with multilevel lumbar spinal tuberculosis. This approach facilitates the removal of lesions and decompression of the spinal cord and is effective in restoring spinal stability, correcting kyphosis, and preventing deterioration of the deformity.