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

A comparative analysis of the short and long-term results of two surgical procedures, radical excision or debridement, for the management of spinal tuberculosis in children is reported. Eighty children (47 treated with radical surgery and 33 with debridement) were prospectively studied and followed to maturity (mean follow-up, 17 years postoperatively). The kyphus and deformity angles were measured from lateral spinal radiographs using an electronic digitizer. The results can be summarized as follows: 1) Long-term clinical outcome of the two surgical procedures were equally good for recovery of neurologic deficit and relief 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 surgical groups. There was an overall correction in these angles after radical surgery, whereas there was a deterioration after debridement surgery; 3) There were no significant differences in the changes in kyphus or deformity angles at final follow-up from their 6-month postoperative measurements between the two surgical groups; 4) The majority of children (56%) showed an improvement in deformity angle of 5-degrees or more after radical surgery at the 6-month postoperative evaluation, whereas 69% of children showed deterioration after debridement surgery; 5) At final follow-up in lumbar tuberculosis, 60% of patients in the debridement 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 surgery (6 months) is important, because it is virtually maintained up to final follow-up.