Anterior surgical interventions in spinal tuberculosis.
OBJECTIVE
To evaluate and compare the effectiveness of the modified Hong Kong procedure performed with and without additional instrumentation, in terms of improvement in neurological and kyphotic disabilities in spinal tuberculosis.


METHODS
Quasi-experimental study.


METHODS
Department of Orthopaedic Surgery, Rawalpindi General Hospital, Rawalpindi, from June 1999 to May 2006.


METHODS
Sixty-two cases of tuberculosis of spine, underwent modified Hong Kong procedure. In 44 cases (group A), no instrumentation was used, while in 18 cases (group B), additional anterior instrumentation in the form of narrow Dynamic Compression Plate (DCP), fixator spinae or Moss Miami instrumentation was used. Changes in the neurological status (following Frankel classification system) and kyphotic angle (as measured on X-ray) after an average of 18 months post-operative follow-up were evaluated and also compared between the two groups using t-test.


RESULTS
There were 23 males and 39 females with mean age of 31.6 +/- 17.1 years. An average neurological improvement of 1.1 +/- 0.7 Frankel grade was achieved overall, which was statistically significant (p < 0.05). There was no significant difference in degree of neurological improvement on comparing the two groups (p = 0.272). In group A patients, mean improvement in kyphotic angle of 2.8 degrees +/- 5.5 degrees was achieved. In group B patients, treated with additional instrumentation, an average 8.9 degrees +/- 7.6 degrees correction was recorded. The difference in improvement between the two groups was statistically significant (p < 0.05).


CONCLUSIONS
Modified Hong Kong procedure alone for spinal tuberculosis (TB) was successful in producing significant neurological recovery. The addition of stabilization instruments achieved better and maintained correction of kyphosis.
Obaid-ur-Rahman
Department of Orthopaedic Surgery, Rawalpindi General Hospital, Rawalpindi. drobaid@hotmail.com
Ahmad
Saleem
S
Hussain
Tayyab
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D011859:Radiography; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult