Komang Agung Irianto

JOURNAL READING
SPICAKENT DINYANTI
NIM. 1710029067
• Indonesia  responsible for 85% of TB cases and 1 of 6
countries where 60% of TB cases were from.
• M. Tuberculosis infection  local destructive effect  ended
up necrotizing the host tissue  cold abscess,
• Necrotic tissue  fail the effectiveness of antimicrobal to stop
the progress of the osteo-joint destruction  the reason for
operative management
• Early surgical treatment : eradicate infection, preserve the
physis, correcting the deformity
• Spinal surgery is still one of the most frightening option for
parents  only treated with TB drug and external mobilization
 another barrier to successful DOT
To compare the efficacy of conserative treatment to surgical
treatment, regarding :
• Pain relieved (VAS)
• Neurological improvement (frankel classification)
• deformity correction (cobb’s angle)
• Retrospective study
• 28 patients of pediatric spine tuberculosis with active new
tuberculosis
• 13 patients with surgical managemet, 15 patients with
conservative management.
• Surgical indications : wide cold abscess, neurogical deficit,
number of level involvement, and progressive kyphotic
deformity
• Conservative management  parent’s decision not to perform
surgery with various reasons.
• TB multidrug for 12 months + external immobilization for 3
months, then replaced with brace until patients are mature
• Surgical procedure : debridement, bone graft, instrumentation
with pedicle screw
• Laboratory and radiological follow up to observe the
effectiveness of the treatment
• Pain score (VAS), neurological deficit (frankel classification),
initial cobb’s angle and one year post treatment
• Cobb’s angle  kyphotic (thoracic vert. Seg.) or lordotic
(lombar or cervical vert. Seg).
• Caused by instability of the spine and compression effect of
dead material

Group Pre treatment Post treatment

surgical 6,13 2,4

Non surgical 6,61 2,7

• Surgical debridement  removing dead necrotic material 
decompress and stabilize  relieving the pressure and
inflamatory effect
 Group improved Not improved

surgical 65,1% 34,9 %

Non surgical 13,3% 86,7%

• Compression of dead material or bone destruction that

encroach the canal. Bad hemodynamic in necrotic lession 
trombosis  affected the function
Deformity Surgical Non Surgical
Improved Not Imporved Improved Not Improved
Kyphotic 57,1 % 42,9% 0% 100%
Lordotic 83.3% 16,7% 74,1% 25,9%
• Surgical Approach is decided according to the level of abscess
and the destructive segment to maximize the evacuation of the
pus, decompress the area, and stabilize the destructive bone
joint.

• While the radical debridement is underway, it is the best to

preserve the remnant growth plate.

• Fresh and healthy tissue + effective antituberculosis treatment

 repair and reform bone and joint faster.

• Healing processes  relief pain faster and reprieve neurologic

deficit optimal growth and alignmnt for the child
• Surgical management showed better outcomes in the degree of
correction (stopped and corrected the kyphosis progression)
and also in the neurogical improvement.
• The pain score was not significant because the evaluation was
conducted one year after diagnosis.