Management of cervical spine tuberculosis in pediatrics: a systematic review

Aim To systematically review the literature on the clinical presentation and management of pediatric cervical spine tuberculosis (CST) and evaluate the outcomes of conservative or surgical treatment based on anatomical location (craniovertebral junction [CVJ], subaxial, and cervicothoracic junction). Method We searched for studies reporting the management for pediatric CST published over the past 20 years. The search flow followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P) criteria. Results This review included a total of 9 studies with a total of 185 patients. The average age at diagnosis was 6.68 ± 3.9 years. The most common presenting symptoms in each anatomical group were as follows: the CVJ group presented with neck pain (90.3%), the subaxial group with neck rigidity (72%), and the cervicothoracic junction group with deformity (84.4%). Most patients in the surgical group showed neurological improvement after surgery (81/86 patients [94.1%]) Improvement in deformity was reported in subaxial and cervicothoracic junction groups managed with combined approach. The extent of surgical debridement in pediatric CST remains debatable. Conservative treatment in the CVJ group provided stability and complete range of motion; whereas, in the subaxial and cervicothoracic junction groups, there have been reports of progressive deformity and limited neck mobility. Conclusion Surgical treatment in combination with appropriate antitubercular medication could improve neurological function and/or deformities. The surgical strategy should be tailored to each patient's condition. Larger comparison studies are needed to provide stronger evidence for the treatment of pediatric CST.