A 2-year-and-9-month-old boy was admitted to our department with back pain that had developed over a 1-month period. Neurological examination revealed a paraparesis, which was evaluated as grade C according to Frankel Scoring System. Roentgenograms of chest and thoracic spine showed destruction at the T5-T6-T7 levels and the local kyphosis angle was 37  at this level. Thoracic magnetic resonance imaging (MRI) demonstrated a large paraspinal abscess involving these three levels, extending to the spinal canal and compressing the spinal cord (Figure 1). There was no other infection focus in physical examination, radiological, hematological, and biochemical tests. Emerge surgical procedure was performed after preoperative evaluation was completed.
The surgery was performed under general anesthesia with the transthoracic approach after removing the fifth rib in right lateral decubit position. After exposure, the paraspinal abscess drained spontaneously. Because of the bone destruction and cord compression, three-level corpectomy was performed at T5-6-7. Sequestered bone fragments of affected vertebrae were removed through corpectomy. Decompression was carried out until duramater was visible through anterior approach, so all affected vertebrae were extracted. The deformity was flexible; the reduction of kyphosis performed until physiological angels and anterior fusion was performed with structural 1 autogenous fibula and 1 autogenous rib graft. Periost of the fibula was prevented and closed anatomically after resection. Anterior instrumentation with one screw to each vertebra at T4 and T8 was performed to increase the primer stability (Figure 2). The system locked, thorax drainage system applied, and thoracotomy closed. The patient was positioned prone. Bilateral polyaxial pedicle screws were inserted at T4 and T8 levels and rods were placed for permanent fixation (Figure 3). Pediatric spinal screw systems were preferred for the immature pedicles (Tasarim med, Istanbul, Turkey).
Microbiological examination of tissue and abscess samples obtained during operation was Mycobacterium Tuberculosis. No complication of bleeding persisted and the drainage tube was taken after 72 hours. One week after surgery, the patient could sit on the bed or walk around under the effective support of thoracolumbosacral orthoses, and this orthoses support was maintained for 3 months. The patient received antituberculosis chemotherapy for 9 months (3 months of INH-rifampicin-pyrazinamide-streptomycin therapy, followed by 6-month INH-rifampicin-pyrazinamide therapy). 6 weeks after surgery, neurological status of the patient was Frankel E and there was no weakness or paresthesia which was presented before the surgery. Kyphosis angle showed a correction of a 4  (89.2%) in the postoperative period and there was no correction loss at the end of follow-up period.