S. Rajasekaran et al., TUBERCULOUS LESIONS OF THE LUMBOSACRAL REGION - A 15-YEAR FOLLOW-UP OF PATIENTS TREATED BY AMBULANT CHEMOTHERAPY, Spine (Philadelphia, Pa. 1976), 23(10), 1998, pp. 1163-1167
Study Design. A 15-year clinical follow-up of tuberculous lesions of t
he lumbosacral region. Objectives. To verify the hypothesis that the l
umbar lordosis and the specific biomechanics of the lumbosacral region
influence and alter the healing pattern and progress of the disease w
hen compared with their effects in other regions of the spine. Summary
of Background Data. An estimated 2 million or more patients have acti
ve spinal tuberculosis, and the global incidence of the disease is inc
reasing. The involvement of the lower lumbar region and the lumbosacra
l junction is relatively rare, with few reports in English literature.
Methods. Of a total of 304 patients forming a part of a controlled cl
inical trial comparing two forms of therapy in spinal tuberculosis, 53
patients had involvement of L3 and below. The following data were stu
died in these patients: age at start of treatment, number of vertebra
involved, vertebral body loss, progress of the angle of kyphosis, and
anterior and posterior growth of the involved segment during a period
of 15 years. Student's t test for independent samples was used for sta
tistical analysis. Results. The fourth lumbar vertebra was the most co
mmon vertebral segment involved, and the lumbosacral junction was affe
cted in 12 patients. The average pretreatment kyphosis was 6.4 degrees
and increased to 10.2 degrees at the end of 15 years. The average kyp
hotic angle per vertebral body loss was 4.9 degrees, far less than in
the dorsolumbar region in which kyphotic angles of 27-30 degrees have
been reported. Children younger than 10 years old differed in clinical
appearance and progress compared with those older than 17 years. They
not only showed more extensive involvement but also had more deformit
y with the same vertebral loss, Twelve patients less than 10 years old
had an average involvement of 3.1 vertebral bodies and an average ver
tebral loss of 2.2 bodies, In comparison, the average number of verteb
rae involved was 1.9 (P < 0.01) and the vertebral body loss was only 0
.87 (P < 0.01) in patients older than 17 years. Also, the average kyph
osis was 6.4 degrees compared with only 4.2 degrees (P < 0.01) in adul
ts. In patients older than 17 years, there was no change after 2 years
, by which time the collapse was complete. Four of 12 patients less th
an 10 years old, showed progressive kyphosis caused by continued growt
h of posterior parts of the body (i.e. sequestrated hemivertebrae). Co
nclusions. In tuberculosis of the lumbosacral region, the development
of kyphosis is minimal in patients older than 17 years, when growth ha
s already stopped, and deformity is expressed more as foreshortening o
f the trunk. Children younger than 10 years old have more severe invol
vement with increased tendency toward greater kyphosis. They are also
prone to progressive deformity through the years when the anterior gro
wth plates are destroyed. Surgery is indicated in this group to preven
t greater deformity.