Kp. Schulitz et al., GROWTH CHANGES OF SOLIDLY FUSED KYPHOTIC BLOC AFTER SURGERY FOR TUBERCULOSIS - COMPARISON OF 4 PROCEDURES, Spine (Philadelphia, Pa. 1976), 22(10), 1997, pp. 1150-1155
Study Design. A study to analyze the changes of the spinal deformity d
uring the growth period, with regard to different operations for spina
l tuberculosis in children. Objectives. To quantify the changes in the
kyphotic angle and the growth ratio of the fusion bloc during spinal
growth for different fusion techniques. Summary of Background Data. Mo
st of the publications dealing with spinal tuberculosis in children fo
cused on the clinical outcome with regard to different conservative an
d operative treatments. There is little reliable information concernin
g the growth of the solidly fused kyphotic bone bloc and its influence
on the changes of the kyphotic deformity after different operative pr
ocedures. Methods. The study included 117 children operated on for spi
nal tuberculosis at the age of 2-6 years at the Ruttonjee Sanatorium i
n Hong Kong during the 1950s and 1960s. Lateral radiographs obtained p
ostoperatively and 5 and 10 years after the operation were analyzed fo
r the growth changes of the solidly fused bone bloc. These results wer
e compared with the different operation techniques (e.g., anterior fus
ion, posterior fusion, combined anterior and posterior fusion, and ant
erior debridement without fusion). Results. The patients treated by an
terior fusion showed the worst results with respect to the kyphotic an
gle. This was especially true when the lesion was located in the thora
cic spine and several segments were involved. Regarding the growth rat
io of the fusion bloc, only the combined fusion and the anterior debri
dement guaranteed an equal growth of the anterior and posterior height
. Conclusions. Radical anterior surgery for spinal tuberculosis destro
ys the anterior growth and limits the capacity for spinal remodeling.
Therefore, it should be avoided, if it is not absolutely necessary, fo
r the healing of the infection or the primary correction of the tuberc
ulous deformity.