Spinal Tuberculosis With Neurological Deficit in Toddlers: Clinical Characteristics, Surgical Management, and Outcomes of Four Cases With Literature Review

Abstract

Background:
Spinal tuberculosis (TB) in very young children is uncommon but may cause extensive vertebral destruction, abscess formation, spinal deformity, and neurological impairment. Diagnosis may be challenging because clinical symptoms can be nonspecific and neurological assessment is often limited by age and cooperation. Literature describing spinal TB in children younger than 5 years remains limited. This study aimed to describe the clinical presentation, radiological findings, surgical management, and early neurological and functional outcomes of children with spinal TB and neurological impairment.

Methods:
A prospective case series was conducted involving children younger than 5 years diagnosed with spinal TB and presenting with lower-extremity paresis or paraplegia. Clinical, neurological, radiological, surgical, and functional outcomes were prospectively documented. All patients received antituberculous therapy and underwent surgical treatment for neurological impairment associated with extensive vertebral destruction and neural compression.

Results:
Four patients, comprising three girls and one boy, aged 2 years 4 months to 2 years 6 months, were included. All presented with progressively enlarging lumbar or paravertebral swelling and destructive spinal lesions with large intracanal abscesses. The involved levels ranged from T12–L1 to L2–L3. Neurological presentation ranged from refusal to walk with preserved spontaneous lower-extremity movement to complete loss of voluntary lower-extremity movement with spasticity. Surgical management was individualized according to disease extent and location. Three patients underwent anterior approaches with debridement and structural reconstruction, while one underwent posterior decompression and fusion with anterior bone graft reconstruction and extensive abscess evacuation. All patients demonstrated neurological improvement. Independent walking was achieved within six weeks to 2.5 months after surgery.

Conclusion:
Spinal TB in children younger than 5 years may present with extensive vertebral destruction, large intracanal and paravertebral abscesses, and severe neurological impairment. Despite severe preoperative deficits, neurological and functional recovery was observed following surgical decompression, debridement, reconstruction, and antituberculous therapy. Early recognition of changes in walking ability and lower-extremity function is important in toddlers. Surgical treatment should be individualized according to neurological status, neural compression, vertebral destruction, and spinal stability, with long-term follow-up because of the risk of growth-related spinal deformity.