Severe thoracic tuberculous spondylitis (Pott’s disease) in a 4-year old child treated with antitubercular treatment and surgical decompression, pedicle screw instrumentation and vertebral body reconstruction - a case report

Introduction: Although very common extrapulmonary form of tuberculosis, the tuberculous spondylitis (TBS) rarely affects very young children ( Case report: We present a case of 4-year old girl with tuberculosis of the tracheobroncheal lymph nodes and TBS affecting Th5-9 vertebral bodies. It was in a poor general condition, malnourished, with severe kyphotic deformity (80°), accompanied with giant midthoracic gibbus, pre- and paravertebral abscess and spinal cord compression on the punctum maximum of the kyphosis. It was neurologically intact at presentation and at time of surgery. It was treated with four tuberculostatic drug combination (Streptomycin, Rifampicn, Isoniazid, Pyrazinamid). It underwent surgery consisting of dorsal decompression – laminectomies Th6-8 followed by unilateral arthropediculotomies at three levels and paravertebral debridment. Pedicle screw instrumentation was done bilaterally at Th 4,5, 9 and 10 vertebrae. An expandable cervical titanium cage was placed instead of the destructed vertebral bodies. With distraction of the intervertebral cage and contraction of the pedicle screw system, correction of the kyphotic deformity was achieved (down to 23° on postoperative CT). Conclusions: Even in very young children pedicle screw fixation and intervertebral reconstruction with expandable cage is feasible and allows deformity correction and stabilization.