title: Longitudinal changes in spinal deformity after anterior spinal surgery for tuberculosis of the spine in adults. A comparative analysis between radical and debridement surgery.
abstract: Of 112 patients who entered the Medical Research Council's prospective study on the surgical management of spinal tuberculosis, 105 were available for review at a mean follow-up of 15.3 years postoperatively. All these patients were age 18 years or more at the time of surgery. Seventy-one patients had radical surgery; the remaining 34 underwent debridement surgery. The longitudinal changes in spinal deformity were evaluated using kyphus and deformity angles from lateral spinal radiographs obtained at preoperative evaluation, postoperatively at 6 months, 1 year, and 5 years, and at final follow-up. The mean kyphos and deformity angles showed correction after radical surgery at 6 months' evaluation; thereafter there were minimal variations up to final follow-up. Those who underwent debridement surgery showed an increase in these angles at 6 months postoperative evaluation; thereafter there were practically no changes in thoracic and thoracolumbar tuberculosis, whereas in lumbar tuberculosis there was spontaneous correction from 1 year post-surgery onward. The changes in mean kyphos and deformity angles at 6 months postoperative evaluation from their preoperative values were significantly different between the two surgical groups, where radical surgery produced better correction. Thus, the choice of surgery--radical or debridement--is important in determining the fate of spinal deformity in the management of tuberculosis of the spine.
authors.affiliation: Duchess of Kent Children's Hospital, Hong Kong.
authors.forename: S S
authors.initials: SS
authors.lastname: Upadhyay
authors.forename: M J
authors.initials: MJ
authors.lastname: Saji
authors.forename: P
authors.initials: P
authors.lastname: Sell
authors.forename: B
authors.initials: B
authors.lastname: Sell
authors.forename: A C
authors.initials: AC
authors.lastname: Yau
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D016025:Bone Transplantation; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D007738:Kyphosis / Q000453:epidemiology* / Q000209:etiology; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D011446:Prospective Studies; D013904:Thoracic Vertebrae / Q000601:surgery*; D013997:Time Factors; D014399:Tuberculosis, Spinal / Q000453:epidemiology / Q000601:surgery*
chemical_list: D000995:Antitubercular Agents