17-YEAR PROSPECTIVE-STUDY OF SURGICAL-MANAGEMENT OF SPINAL TUBERCULOSIS IN CHILDREN - HONG-KONG OPERATION COMPARED WITH DEBRIDEMENT SURGERYFOR SHORT-TERM AND LONG-TERM OUTCOME OF DEFORMITY

A comparative analysis of the short and long-term results of two surgi cal procedures, radical excision or debridement, for the management of spinal tuberculosis in children is reported. Eighty children (47 trea ted with radical surgery and 33 with debridement) were prospectively s tudied and followed to maturity (mean follow-up, 17 years postoperativ ely). The kyphus and deformity angles were measured from lateral spina l radiographs using an electronic digitizer. The results can be summar ized as follows: 1) Long-term clinical outcome of the two surgical pro cedures were equally good for recovery of neurologic deficit and relie f of pain. There was no incidence of reactivation and/or recurrence of tuberculous lesion in either group; 2) The mean changes in kyphus and deformity angles at the 6-month postoperative evaluation compared to their preoperative value were significantly different for the two surg ical groups. There was an overall correction in these angles after rad ical surgery, whereas there was a deterioration after debridement surg ery; 3) There were no significant differences in the changes in kyphus or deformity angles at final follow-up from their 6-month postoperati ve measurements between the two surgical groups; 4) The majority of ch ildren (56%) showed an improvement in deformity angle of 5-degrees or more after radical surgery at the 6-month postoperative evaluation, wh ereas 69% of children showed deterioration after debridement surgery; 5) At final follow-up in lumbar tuberculosis, 60% of patients in the d ebridement group had 10-degrees or more kyphus angle, whereas only one patient in the radical group had a kyphotic lumbar spine due to graft failure. In conclusion, the status of deformity achieved after surger y (6 months) is important, because it is virtually maintained up to fi nal follow-up.