| disease | Tuberculous Kyphosis |
Spinal subcutaneous node kyphosis, especially in children under 10 years old, is one of the serious sequelae. It not only affects the patient's appearance and causes psychological stress, but severe thoracic or thoracolumbar subcutaneous node kyphosis can also impair cardiopulmonary function and may lead to delayed-onset healed lesion-type paraplegia.
bubble_chart Epidemiology
Beijing Subcutaneous Node Disease Research Institute Wu Qi analyzed 50 cases of children's spinal subcutaneous nodes during the Autumnal Equinox (16th solar term). The age range was 2 to 14 years, with an average of 9.2 years, and the gender ratio was approximately equal. Lesions were found in the cervical-thoracic spine in 4 cases, thoracic spine in 26 cases, thoracolumbar spine in 4 cases, and lumbar spine in 16 cases. The maximum number of affected vertebrae was 7, the minimum was 1, with an average of 2.9, which is higher than the usual case average of 2.2. The follow-up period ranged from a maximum of 25 years to a minimum of 2 years, with an average of 11 years. At follow-up, 18 cases (36%) were under 14 years old, and the kyphotic deformity in these cases would continue to progress. In 32 cases (64%) aged 16 to 25 years, the kyphotic deformity had already been finalized.
Factors affecting spinal kyphotic deformity include the patient's age, the initial angle of kyphotic deformity, the number of affected vertebrae, the number of vertebrae completely lost during treatment, and the level of the lesion in the spine.
It is generally believed that the age at which longitudinal growth and development of the spine is completed is 17 to 23 years. If a patient is in the stage of spinal growth and development and one vertebra is completely destroyed, the average final angle of kyphotic deformity is approximately 33°.
Follow-up results indicate that at the site of the bone defect in the lesion, the deformity stops progressing only after the adjacent vertebrae above and below come into close contact.bubble_chart Clinical Manifestations
The level of the lesion in the spine has a significant impact on the degree of kyphosis. For the same vertebral destruction, lesions in the thoracic or thoracolumbar spine result in more severe kyphosis than those in the lumbar spine.
1. Lesions at L4 or L5, even with complete loss of one vertebral body, have little effect on spinal kyphosis. This may be compensated by the inherent lumbar lordosis.
2. In the thoracic or thoracolumbar spine, subcutaneous nodes causing complete loss of one, two, or three vertebral bodies will ultimately lead to kyphosis of 30°–90°. In this group, 23 cases (46%) fell into this category, with kyphosis reaching around 70°. Reports indicate that the destruction of a single vertebral body results in final kyphosis of 33° in the thoracic spine, 37° in the thoracolumbar spine, and only 24° in the lumbar spine, showing a clear difference. Severe kyphosis (>100°) appears to be more concentrated in cases with subcutaneous nodes in the lower thoracic spine.
3. The age at which seasonal disease treatment begins has a significant influence on the degree of progressive kyphosis in patients. For patients whose spinal growth and development are complete, kyphosis mostly appears within 12 months of treatment, with little progressive increase in the subsequent two years.
In growing children, if the initial kyphosis is <40° and the lesion is in the thoracolumbar or lumbar spine, the kyphosis may decrease or remain unchanged. Conversely, if the initial kyphosis is >40°, it will progressively increase as the child's spine develops.
The diagnosis can be made based on medical history, signs, and X-ray films.bubble_chart Treatment Measures
For patients with subcutaneous nodes in the thoracic or thoracolumbar spine, surgical intervention with intervertebral bone grafting is required to prevent progressive deformity when 0.75 or more thoracic vertebral bodies are destroyed or lost, or when 1.5 or more lumbar vertebral bodies are lost.
Intervertebral bone grafting is an effective measure to prevent the occurrence and progression of kyphosis. When the mechanical strength of the bone graft is insufficient, especially in the thoracolumbar region, the graft may fracture or sink into the cancellous bone. If rib grafts are used to span more than two defective vertebral bodies, the grafts are prone to fracture or displacement, which can be avoided by using fibular grafts. Reports indicate a 59% failure rate in bone grafting. Postoperative imaging should confirm intervertebral fusion, and patients should wear a "brace" when necessary during rehabilitation exercises.
For children under ten years old with kyphosis of 40° or more, surgical intervention is indicated due to the risk of progressive increase in spinal kyphosis as the spine grows.
