Gokhan Cavus1, Yurdal Gezercan2, Ali Ihsan Ökten2, Orkun Tolunay3, Tamer Çelik3, Ali Arslan2, Ümit Çelik3. 1. Department of Neurosurgery, Adana Numune Training and Research Hospital, Serinevler Mah, Ege Bağatur Bulvarı, 01260, Yüreğir, Adana, Turkey. gokhanctf@yahoo.com. 2. Department of Neurosurgery, Adana Numune Training and Research Hospital, Serinevler Mah, Ege Bağatur Bulvarı, 01260, Yüreğir, Adana, Turkey. 3. Department of Pediatrics, Adana Numune Training and Research Hospital, Yüreğir, Adana, Turkey.
Abstract
PURPOSE: Tuberculosis is a common disease worldwide that is caused by Mycobacterium tuberculosis. Tuberculosis is primarily a pulmonary disease, but extrapulmonary manifestations are not uncommon, especially in children and adolescents. METHODS: We present two pediatric patients who underwent surgery in our clinic for Pott's disease in the upper thoracic region. The patients were investigated to describe their age, complaints, neurological examination results, disease location, surgical procedure, and complications. RESULTS: The patients were 2 and 14 years old and exhibited disease located in the upper thoracic region (T2-T3 and T1-T2). Both patients displayed severe neurological deficits (Frankel B and C). The kyphotic angles were 82.2° and 43.2°. The patients were stabilized by applying fusion using transpedicular screws via a posterior approach. They also underwent anti-tuberculosis treatment for approximately 1 year. One year later, neither patient exhibited any neurological deficit, and their kyphotic angles were measured as 11° and 1°, respectively. CONCLUSIONS: The recommended treatment approach for unstable cases of Pott's disease located in the upper thoracic region who exhibit neurological deficit and severe kyphotic angling or the development of kyphosis on the thoracic vertebrae is surgical. Decompression, stabilization, and fusion and kyphotic correction can be safely performed via a posterior approach. One of the present cases is the youngest patient described in the literature to undergo transpedicular surgery as a result of Pott's disease. Our other case is the first described in the literature who developed ptosis as a result of tuberculosis and underwent a procedure via posterior transpedicular screw.
PURPOSE:Tuberculosis is a common disease worldwide that is caused by Mycobacterium tuberculosis. Tuberculosis is primarily a pulmonary disease, but extrapulmonary manifestations are not uncommon, especially in children and adolescents. METHODS: We present two pediatric patients who underwent surgery in our clinic for Pott's disease in the upper thoracic region. The patients were investigated to describe their age, complaints, neurological examination results, disease location, surgical procedure, and complications. RESULTS: The patients were 2 and 14 years old and exhibited disease located in the upper thoracic region (T2-T3 and T1-T2). Both patients displayed severe neurological deficits (Frankel B and C). The kyphotic angles were 82.2° and 43.2°. The patients were stabilized by applying fusion using transpedicular screws via a posterior approach. They also underwent anti-tuberculosis treatment for approximately 1 year. One year later, neither patient exhibited any neurological deficit, and their kyphotic angles were measured as 11° and 1°, respectively. CONCLUSIONS: The recommended treatment approach for unstable cases of Pott's disease located in the upper thoracic region who exhibit neurological deficit and severe kyphotic angling or the development of kyphosis on the thoracic vertebrae is surgical. Decompression, stabilization, and fusion and kyphotic correction can be safely performed via a posterior approach. One of the present cases is the youngest patient described in the literature to undergo transpedicular surgery as a result of Pott's disease. Our other case is the first described in the literature who developed ptosis as a result of tuberculosis and underwent a procedure via posterior transpedicular screw.
Authors: Brian L Pettiford; Matthew J Schuchert; Geetha Jeyabalan; James R Landreneau; Arman Kilic; Joshua P Landreneau; Omar Awais; Michael S Kent; Peter F Ferson; James D Luketich; Andrew B Peitzman; Rodney J Landreneau Journal: Ann Thorac Surg Date: 2008-12 Impact factor: 4.330