Case Report Kepada Yth.

Infection Unit
SPINAL TUBERCULOSIS
Presenter : Tri Faranita
Day/Date : Saturday/ July 30
th
2011
Supervisor in charge : Dr. a!id Di"yati# Sp$%&'
(onsultants : Dr. ). *id+an ,. Daulay# Sp$%&'
Dr. -is"an Dali"unthe# Sp$
Dr. *ini Savitri Daulay# ,&ed Ped# Sp$
Introduction
(hildhood tu.erculosis# de/ined as tu.erculosis in children younger than 10 years# is a direct
re/lection o/ the adult tu.erculosis +ithin a co""unity. (hildhood tu.erculosis usually
represents recent trans"ission /ro" an in/ectious adult or adolescent and is considered a sentinel
event in pu.lic health.
1
Tu.erculosis %T.' is pri"arily a pul"onary disease# .ut e1tra2pul"onary
"ani/estations are not unco""on# especially in children and adolescents.
2
The "ost co""on
/or"s o/ e1trapul"onal disease in children include T. o/ the super/icial ly"ph nodes# and the
central nervous syste". 3ther rare /or"s o/ e1trapul"onal disease in children are osteoarticular#
a.do"inal# gastrointestinal# genitourinary# cutaneous# and congenital disease.
1
,usculos4eletal T. in/ection can potentially a//ect any .one# 5oint# tendon# or .ursa in
the .ody.
3
Follo+ing in/ection# all children progress through an asy"pto"atic incu.ation period.
The su.se6uent develop"ent o/ clinical disease is deter"ined .y the interaction o/ the host# and
the organis"# and is highly age dependent.
1
,usculos4eletal T. is typically su.se6uent to an
initial pri"ary T. in/ection and he"atogenous or ly"phatic seeding o/ .acilli. 7t is possi.le +ith
reactivation o/ latent T. in a patient.
3
The incidence rates o/ T. are highest in developing countries# .ut the rates have .een
increasing in -estern societies.
2
81trapul"onal T. consists o/ 102209 o/ these patients.
:
S4eletal T. is 109 o/ this# o/ +hich spinal T. osteo"yelitis# or Pott;s disease# has the greatest
prevalence o/ all "usculos4eletal sites.
3#:
7t a//ects the spine up to 009 o/ all osteoarticular T.
patients. Spinal T. occurs "ost co""only in children and young adults. 7t causes .one
destruction# spinal de/or"ity and neural co"plications.
0

The diagnosis o/ this disease is .ased on clinical and radiological evidences# particularly
in the ende"ic areas o/ the +orld. 7n children# di//iculties on "a4ing right diagnosis +as
.ecause o/ t+o things# only a /e+ o/ .acteria +as /ound %pauci.acillary' and di//iculties on
ta4ing speci"en.
0#<
The clinical sy"pto"s o/ spinal T. in children are o/ten insidious and
include .ac4 pain# /ever# paraparesis# sensory distur.ance and .o+el and .ladder dys/unction.
1
Plain radiographs i"ages "ight .e nor"al or "ay sho+ "ild osteopenia in early disease. The
collapse o/ the interverte.ral disc space occurs +hen disc involve"ent happens.
0
The spinal tu.erculosis treat"ent targets are to con/ir" the diagnosis# eradicate the
in/ection# achieve a deco"pression o/ the spinal canal "aterial and correct or prevent spinal
de/or"ity and possi.le se6uelae.
0
7n general# reco""ended treat"ent /or e1trapul"onal
tu.erculosis is the sa"e as /or pul"onary tu.erculosis.
1
(onservative treat"ent# including
che"otherapy and orthopedic i""o.ili!ation# re"ains the cornerstone o/ the "anage"ent o/
spinal T. in children.
0
The aim of this paper is to report a case of spinal tuberculosis in a 11 years old boy.
Case
JS# "ale# 11 years old# 7ndonesian# ad"itted to ). $da" ,ali4 )ospital on July 2=
th
2010# +ith
"ain co"plain o/ a "ass on his .ac4 since 1 year ago. 7nitially the "ass +as s"all and getting
larger as si!e as hand /ist. Pain +as /ound on the site o/ the "ass since 1 "onth ago. >na.le to
+al4 +as suddenly happened since 1 "onth ago and he cannot stand on .oth /eet. Fever and
cough +ere not /ound. Decrease o/ appetite and +eight loss +as /ound. )istory o/ trau"a +as
not /ound. )istory o/ direct contact to persons +ith active pul"onary disease +as unclear# his
grand/ather su//ered /ro" recurrent cough. >rinated and de/ecation +ere nor"al. 7""uni!ation
status +ere co"plete.
Physica e!a"ination
(onsciousness +as clear# .ody +eight %?-': 20 4g# .ody length %?@': 120 c"# ?-/?@: =A.09#
.ody te"perature: 3A
0
(. Beneral and disease condition +ere "oderate# and nutritional status
+as "ild "alnutrition.
)ead : 8yes : @ight re/le1es %C/C'# pupils +ere isochoric
Do pale on lo+er eyelid con5unctives and lips. 8ars and nose +ere nor"al
Dec4 : @y"ph nodes enlarge"ent +as not /ound
(hest : Sy""etrical /usi/or"# no retraction
)* : E= .p"# regular# no "ur"ur
** : 22 tp"# regular# no rales
Thoracolu".al: gi..us +as /ound
$.do"en : So/t# peristaltic nor"al# liver and spleen +ere not palpa.le
81tre"ities : Pulse : E= .p"# regular# P/F +as good. ?lood pressure : E0/<0 "")g
?(B scar +as /ound on right deltoid region.
,otoric syste" :
,uscle tone: nor"otone
,uscle strength : 00000 00000
11111 11111
Physiological re/le1es: ?iceps/Triceps CD/CD CD/CD
2
&P*/$P* CD/CD CD/CD
Pathological re/le1es : 2
La#oratory $indin% on &uy '(
th
')*):
)e"oglo.in 10.= gr/d@# )e"atocrite 3:.=9# @eucocytes 0 2A0/""
3
# Platelet :A2 000/""
3

,(F =2.2 /@# ,() 2:.2 pg# ,()( 2E.0 g9# *D- 1A.=9# 8rythrocyte :.=1110
<
/""
3

>reu" 1:.E "g/d@# (reatinine 0.30 "g/d@# >ric acid 0.3 "g/d@# ?iliru.in total 0.<2 "g/d@#
?iliru.in direct 0.1A "g/d@# $@P 300 >/@# $ST 2= >/@# $@T 20 >/@
+or,in% -ia%nosis. Paraparesis ec. suspect spinal tu.erculosis
Therapy .
- Diet regular /ood 1E20 calories +ith :2 g protein
Pannin% .
2 ,antou1 test
2 Bastric lavage
2 (hest G ray
2 Thoracolu".al G ray
2 (onsult to orthopedic depart"ent
2 (onsult to "edical reha.ilitation depart"ent
/oo0 up on &uy '1
th
2 Au%ust 3
th
')*)
S : ,ass on the .ac4. >na.le to +al4.
3 : Sens : (, T : 3<.= H 3A.2 ( ?-: 20 4g
)ead : 8yes : @ight re/le1es %C/C'# pupils +ere isochoric.
Do pale on lo+er eyelid con5unctives and lips. 8ars and nose +ere nor"al.
Dec4 : @y"ph nodes enlarge"ent +as not /ound
(hest : Sy""etrical /usi/or"# no retraction
)* : E02E< .p"# regular# no "ur"ur
** : 20222 tp"# regular# no rales
Thoracolu".al: gi..us +as /ound
$.do"en : So/t# peristaltic nor"al# liver and spleen +ere not palpa.le
81tre"ities : Pulse : E02E< .p"# regular# P/F +as good. ?lood pressure : E0/<0 "")g
,otoric syste" :
,uscle tone: nor"otone
,uscle strength : 00000 00000
11111 11111
Thoraca 4 ray on &uy 5)
th
')*)
3
The corpus o/ thoracal 11 and lu".al 1 +as /lat. (orpus o/ thoracal 12 cannot .e seen clearly.
$nterior discus o/ th11/th12 and th12/l1 +ere tight. Th11 and l1 /or"ed angular shape.
(onclusion : Spondylitis T. on thoracal 11# 12 and lu".al 1.
6antou! test resuts : induration 10 ""
Consutation resuts $ro" "edica reha#iitation depart"ent on &uy 5)
th
')*)
Diagnosis: Paraparesis ec. spondylitis tu.erculosis
$dvice: physiotherapy 3 ti"es a +ee4# in/rared# e1ercise and occupation therapy
Consutation resut $ro" orthopedic depart"ent on Au%ust 3
st
')*)
Ta4ing over patient treat"ent i/ there +ere nothing "ore to do in pediatric +ard.
$ : Paraparesis ec. spinal tu.erculosis
P :
- 7sonia!id 1 1 200"g
- *i/a"picin 11300"g
- Pyra!ina"ide 21200"g
- 8tha".utol 11:00"g
- Prednisone ta. 0"g %3 H 3 H 2'
- Fita"in ?< 1120"g
- Diet regular /ood 1E20 calories +ith :2 g protein
/oo0 up on Au%ust 7
th
2 *'
th
')*) 8Orthopedic 0ard9
S : ,ass on the .ac4. >na.le to +al4. (an "ove .oth legs.
3 : Sens : (, T : 3<.E H 3A.3 ( ?-: 20 4g
)ead : 8yes : @ight re/le1es %C/C'# pupils +ere isochoric.
Do pale on lo+er eyelid con5unctives and lips. 8ars and nose +ere nor"al.
Dec4 : @y"ph nodes enlarge"ent +as not /ound
(hest : Sy""etrical /usi/or"# no retraction
)* : E22E< .p"# regular# no "ur"ur
** : 20222 tp"# regular# no rales
Thoracolu".al: gi..us +as /ound
$.do"en : So/t# peristaltic nor"al# liver and spleen +ere not palpa.le
81tre"ities : Pulse : E22E< .p"# regular# P/F +as good. ?lood pressure : E0/<0 "")g
,otoric syste" :
,uscle tone: nor"otone
,uscle strength : 00000 00000
22222 22222
:astric a;a%e cuture resuts.
Did not /ind any 4inds o/ .acteria
4
$ : Paraparesis ec. spinal tu.erculosis
P :
- 7sonia!id 1 1 200"g
- *i/a"picin 11300"g
- Pyra!ina"ide 21200"g
- 8tha".utol 11:00"g
- Prednisone ta. 0"g %3 H 3 H 2'
- Fita"in ?< 1120"g
- Diet regular /ood 1<=0 calories +ith :2 g protein
This patient +as discharged /ro" the hospital on $ugust 12
th
2010 and planned to have posterior
sta.ility surgery a/ter ta4ing antitu.erculosis "edication /or a "onth.
-iscussion
There are "any ris4 /actors /or the develop"ent o/ T. in/ection. People at greatest ris4 /or T.
include those +ho are in correctional /acilities# nursing ho"es# ho"eless shelters and healthcare
/acilities. This is thought to .e due to an increased ti"e o/ close e1posure to persons +ith active
pul"onary disease. (hildren are noted to have greater ris4 o/ developing e1trapul"onal T. in
co"parison +ith adults. 7n the "usculos4eletal syste"# any .one# 5oint# tendon# or .ursa has the
potential /or T. in/ection. $dults +ill "ore co""only have in/ection at the 4nee# +hereas
children +ill "ore co""only have in/ection o/ the hip and spine.
3
7n children# the "ain route o/
in/ection o/ spinal tu.erculosis is through he"atogenous spread /ro" a pri"ary site o/ in/ection#
+hich is o/ten un4no+n. Spinal tu.erculosis in children co""only a//ects the dorsal spineI
cervical spine involve"ent occurs in less than 09 o/ the patients.
0
The upper levels o/ the
thoracic spine are "ost co""only in/ected.
3
This patient is a .oy 11 years old +ith history o/ close e1posure to persons +ith active
pul"onary +as unclear %his grand/ather'# +hich is live in the sa"e house and already passed
a+ay.
The signs and sy"pto"s o/ spinal T. include night cries and restless sleep# a lo+ grade
daily /ever# and a peculiar position or gait.
2
Patients usually e1perience locali!ed pain# sti//ness#
and paraspinal "uscle spas"# +hich "ay progress over 2 H 0 "onths.
3
Deurologic de/icit is seen
in 1092:A9 o/ the patients. 7t is generally developed secondary to radicular and "edullar
in/la""ation. The "ost /re6uent clinical sy"pto" reported in patients +ith spinal tu.erculosis
+as +ea4ness in the /eet. 7t +as reported that the children +ould co"e to the hospital only 1
"onth a/ter the .eginning o/ sy"pto"s.
A
Findings on physical e1a"ination "ay include "ar4ed
guarding .ecause o/ dorsal "uscle spas"# pain +hen the .ac4 is pounded# a de/or"ity %such as
gi..us'# or re/le1 changes %including clonus'.
2
These clinical "ani/estation usually /ound and
recogni!ed a/ter trau"a.
<
3nly on progression o/ the 4yphosis# +ith evidence o/ severe shape
5
de/or"ity# and +ea4ness in the /eet# +ith ina.ility to +al4# +as the patient .rought to the
hospital.
A
7n this case# the /irst sy"pto"s that .rought hi" to see4 "edical help +as the "ass on
the .ac4 +hich +as gi..us. Pain on the "ass +as /ound and reducing a/ter treat"ent. >na.le to
+al4 +as happened since one "onth ago initially .egan +ith the +ea4ness in the /eet. Beneral
sy"pto"s# decreased o/ appetite and +eight loss# +ere /ound. *ecurrent lo+ grade /ever and
chronic cough +ere not /ound. )istory o/ trau"a +as not /ound# this +as usually .eing the /irst
event that patient re"e".ered.
The classic appearance o/ spinal T. on plain /il"s is +ell descri.ed. The lesion is
typically seen to a//ect t+o or "ore ad5acent verte.ral .odies +ith loss o/ the intervening disc
space# o/ten acco"panied .y a paraverte.ral so/t tissue shado+. $typical radiographic /eatures
are descri.ed as centroso"ic# +hich "ay progress to verte.rae plana and .e con/used +ith
"alignancy.
:
7n children# verte.ral destruction is "ore severe than adults. 7t +as reported that
spinal T. in children a//ects three or "ore verte.ral .odies.
0#A
The literature reports the
sensitivity o/ plain radiography to .e .et+een E1 and EE9.
:
The (T scan is use/ul in
de"onstrating .ony sclerosis and destruction# especially in the posterior ele"ents# +hich are
di//icult to assess .y conventional radiography. 7t is also a use/ul techni6ue in guiding
percutaneous .iopsy# ho+ever# the (T scan is in/erior to the "agnetic resonance i"aging
%,*7'.
0
,*7 is the /irst choice /or i"aging# it detects spinal T. :2< "onths earlier co"pared
+ith the conventional "ethods. This can reveal paraspinal a.scess# cord co"pression# and
degenerative changes o/ so/t tissues.
0#A

7n this case +e only per/or"ed thoracal anteroposterior and lateral position plain /il"s.
Fro" radiologic /indings sho+ed destruction on the corpus o/ thoracal 12. The angular shape
+as /or"ed .y thoracal 11 and lu".al 1. These /indings suggest spinal tu.erculosis.
7n general# spinal tu.erculosis can .e con/idently diagnosed .y clinical and radiographic
tools. 7t +as con/ir"ed .y radiological characteristic /indings conco"inant +ith other positive
/indings such insidious clinical history o/ /ever and anore1ia# positive tu.erculin s4in test#
suggestive chest radiography/chest (T scan /indings and/or a positive response to
antitu.erculous drug therapy.
0
@ess than hal/ o/ those +ith osteoarticular T. +ill de"onstrate
any evidence o/ a pul"onary T. in/ection on chest 12ray /il".
3
7/ any case does not /it into the
classical clinical or radiological /indings suggestive o/ spinal tu.erculosis# surgical treat"ent or
at least needle aspiration should .e per/or"ed and ade6uate tissue should .e o.tained /or
histopathological e1a"ination and /inal diagnosis.
0
7n this case# +e esta.lished the diagnosis +ith clinical sy"pto"s# tu.erculin test and
radiologic /indings. -e /ound general sy"pto"s and local sy"pto"s o/ the disease Tu.er4ulin
test sho+ed 10"" induration suggest positive results. $nd /ro" thoracal 1 ray +e /ound
destruction o/ the corpus and disc space narro+ing# .ut /ro" chest 12ray +e didn;t /ind any
a.nor"alities.
6
The "ost co""on di//erential diagnosis in children is verte.ral osteo"yelitis. The
insidious onset o/ the disease# the s"ooth "argins o/ the paraspinal "ass and the ri"
enhance"ent o/ this "ass in ,*7 are the "ain criteria /or distinguishing verte.ral tu.erculosis
/ro" pyogenic spondylitis.
0
Deurological co"plications and spinal de/or"ity are the "ost dreaded co"plications o/
tu.erculosis o/ spine. Deurological co"plications develop in the active or healed stage o/ the
disease.
=
Pott;s paraplegia resulting in severe spinal de/or"ity is a disastrous co"plication#
+hich is di//icult to treat .y antitu.erculous drugs alone and/or .y surgical deco"pression.
E
The
se6uelae o/ these t+o co"plications a//ect the 6uality and span o/ li/e. $l"ost all tu.erculosis o/
spine# even i/ they are treated +ell# leave .ehind so"e a"ount o/ 4yphosis in di//erent seg"ents
o/ spine.
=
Spinal de/or"ities continue to advance during gro+th. The spinal cord undergoes
intrinsic changes that produce late onset paraplegia# +ith conse6uent poor chances o/ neural
recovery a/ter surgery.
=#E
-ith the introduction o/ antitu.ercular drugs the treat"ent o.5ective
.eca"e achieving the healed status# .ut there +as a resulting se6uelae o/ 4yphosis. Do+# the
o.5ective is to cure the disease# +ith no se6uelae o/ neural co"plications and an al"ost near2
nor"al spine.
10

Treat"ent o/ tu.erculosis is designed to prevent the co"plications o/ disease in the host
and the develop"ent o/ drug2resistance in the organis". $nti"yco.acterial agents should .e
.actericidal and e//ective against intra2 and e1tracellular organis"s.
1
There are three "ain areas
to consider regarding the che"otherapy o/ osteoarticular T. in children: the regi"en to .e used#
the dosages o/ the drugs that should .e used in children and the length o/ treat"ent.
13
Three or
"ore drugs are used e"pirically /or initial therapy. 3steoarticular T. should .e treated +ith an
intensive phase o/ t+o "onths o/ isonia!id# ri/a"picin and pyra!ina"ide# acco"panied .y
etha".utol i/ there is any possi.ility o/ drug resistence.
1#13
*eco""ended treat"ent in 7ndonesia
includes 12 "onths o/ isonia!id and ri/a"pin# pyra!ina"ide and etha".utol is added in the /irst
t+o "onths.
<

Pyrido1ine is reco""ended /or in/ants# children# and adolescents treated +ith isonia!id
+ho have nutritional de/iciencies# sy"pto"atic )7F in/ection# and diets lo+ in "il4 or "eat
products. (orticosteroid ad"inistration is .ene/icial in the "anage"ent o/ children +hen the
host in/la""atory reaction contri.utes signi/icantly to tissue da"age or i"paired /unction.
Prednisone is "ost co""only e"ployed.
1#1:
7n this case# +e planned to give antitu.erculous drugs /or 12 "onths. 7n the /irst 2
"onths +e treated the patient +ith : antitu.erculous drugs %ri/a"picin# isonia!id# pyra!ina"id
and etha".utol' and the other = "onths +e planned to continue giving isonia!id and ri/a"picin..
-e also give pyrido1ine and corticosteroids /or this patient as ad5unctive therapy.
Surgical "anage"ent o/ tu.erculous spondylitic 4yphosis is indicated i/ there is a lac4 o/
response to anti.iotics# a severe and/or progressive 4yphosis# or a developing neurological
7
de/icit. $ severe 4yphotic de/or"ity developing /ro" spinal tu.erculosis o/ten re6uires surgical
treat"ent to eradicate in/ection# restore align"ent and reduce pain. $nterior de.ride"ent has
traditionally .een the procedure o/ choice to de.ride in/ected .one and so/t tissue and
deco"press neural ele"ents. Sta.ility can .e achieved .y either anterior or posterior
instru"ented /usion.
11
7t is sa/e in spinal T.. -hen tu.ecular lesions result in progression o/
4yphosis to "ore than 00 degrees# the de/or"ity should .e surgically corrected to restore sagittal
.alance. The choice o/ operation depends on the "agnitude o/ correction re6uired.
10#11

$n accurate assess"ent o/ the spinal cord condition# the length o/ the co"pressed cord
seg"ent in the spinal canal# and a "easure"ent o/ the length o/ the verte.ral canal and colu"n
/or posterior de/or"ity correction surgery are very i"portant in selecting the "ost e//ective
"ethod o/ treat"ent to reverse the paralysis.
E
8arly spine /usion /or de/or"ity produced /ar
.etter results than delayed /usion. $ solid /usion at the end o/ gro+th re"ained unchanged.
8arly /usion +as /ar superior to delayed or non surgical treat"ent.
12
7n this case# +e consulted the patient to orthopedic depart"ent /or "a1i"i!ing the
"otoric /unction o/ .oth legs. 3rthopedic depart"ent suggested surgical treat"ent. Posterior
sta.ility +as planning to do a/ter the patient ta4ing antitu.erculous "edication /or one +hole
"onth.
The develop"ent o/ severe 4yphosis and its se6uelae can .e prevented .y diagnosing
spinal T. early .e/ore a 4yphosis develops# identi/ying those spinal T. +hich are li4ely to have
severe 4yphosis at the end o/ the treat"ent and progression +ith gro+th# and .y correcting
angular 4yphosis in active stage o/ disease.
=
Patients +ho develop paraplegia early in the active
stages o/ tu.erculosis re6uire aggressive treat"ent. These patients do .etter that those +ho
develop paraplegia years a/ter the initial disease has healed.
11
The late diagnosis and treat"ent o/
spinal tu.erculosis seriously increases the "ortality and "or.idity in children.
A
The li/e e1pectancy o/ hu"an .eings has increased glo.ally. 7/ de/or"ity is "oderate to
severe# these patients report 10220 years later +ith the clinical pro.le"s related to persistent
spinal de/or"ity and paraplegia +ith the healed disease.
=
This +as a late diagnosis case and the patient re6uires aggressive treat"ent. The
prognosis +as depends on the regularity ta4ing "edication and the surgical treat"ent.
>n/ortunately# the patient never ca"e to do the /ollo+ up and +e have also tried to reach hi"
.ut the personal in/or"ation that they gave is incorrect.
Concusion
7t has .een reported a case o/ spinal tu.erculosis in a 11 years old .oy. The diagnosis +as
esta.lished .ased on history# physical e1a"inations# tu.erculin s4in test and radiology
e1a"inations. (lose "onitoring# surgical intervention and physical e1ercise +ere needed to have
opti"al results on the case. -e need to intensi/y coordination /ro" pediatric depart"ent#
8
orthopedic depart"ent and "edical reha.ilitation depart"ent /or "anaging a case +ith spinal
tu.erculosis.
Re$erences
1. ,andala4as $# Star4e J*. Tu.erculosis and nontu.erculosis "yco.acterial disease. 7n:
(hernic4 F. editors. &endig;s disorders o/ the respiratory tract in children. A
th
ed.
Philadelphia: Saunders 8lsevierI 200<. p. 00A22E
2. Song Di# Sohn S# &i" &# 8un S)# *hie J# Jang B# et al. $ childhood case o/ spinal
tu.erculosis "isdiagnosed as "uscular dystrophy. &orean J Pediatr. 2010I03:<0A2<0
3. Jycho+ic! ,8. 3steoarticular "ani/estations o/ "yco.acteriu" tu.erculosis in/ection.
3rthop Durs. 2010I2E::002<
:. Polley P. Dunn *. Doncontiguous spinal tu.erculosis: incidence and "anage"ent. 8ur
Spine J. 200EI1=:10E<2101
0. ?en!ag"out ,# ?ou5ra/ S# (ha4our &# (haoui ,8F. Pott;s disease in children. Surg
Deurol 7nt. 2011I2:120
<. *aha5oe D# ?asir D# &artasas"ita (?# ,a4"uri ,S# editors. Pedo"an nasional
tu.er4ulosis ana4. 2
nd
ed. Ja4arta: PP 74atan Do4ter $na4 7ndonesiaI 200=
A. &ry"a! D# il"a! D# De"ir 3. Spinal cord co"pression /ro" spinal tu.erculosis in a
child. Pediatr Deurosurg. 200<I:2:1=022
=. Jain $&# Dha""i 7&# Jain S# ,ishra P. &yphosis in spinal tu.erculosis2prevention and
correction. 7ndian J 3rthop. 2010I:::12A23<
E. ,oon ,S# ,oon J@# ,oon -# &i" SS# Sun D)# (hoi -T# et al. Pott;s paraplegia in
patients +ith severely de/or"ed dorsal or dorsolu".ar spines: treat"ent and prognosis.
Spinal (ord. 2003I:1:1<:2A1
10. Jain $&# Jain S. 7nstru"ented sta.ili!ation in spinal tu.erculosis. 7nt 3rthop. 2011IA:1211
11. 7ssac4 PS# $d5ei 3?. Surgical correction o/ 4yphotic de/or"ity in spinal tu.erculosis. 7nt
3rthop. 2011I<:12<
12. -inter *?# @onstein J8. >ltra2long2ter" /ollo+2up o/ pediatric spinal de/or"ity
pro.le"s:23 patients +ith a "ean /ollo+2up o/ 01 years. J 3rthop Sci. 200EI1::13223A
13. Donald P*. The che"otherapy o/ osteo2articular tu.erculosis +ith reco""endations /or
treat"ent o/ children. J 7n/. 2011I<2::1123E
1:. Star4e J*# ,uno! *,. Tu.erculosis. 7n: ?ehr"an *8# &lieg"an *,# Jenson )?# editors.
Delson te1t.oo4 o/ pediatrics. 1=
th
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