17-Year Prospective Study of Surgical Management of Spinal Tuberculosis in Children: Hong Kong Operation Compared with Debridement Surgery for Short- and Long-Term Outcome of Deformity


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Abstract

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) ware prospectively studied end 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 off 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) This mean changes in kyphus and deformity angles at the 6-month postoperative evaluation compared to their preoparative value ware significantly different for the two surgical groups, There was an overall correction in these angles after radical surgery, where as 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 6$$ or more after radical surgery at the 6-month postoperative evaluation, where as 69% of children showed deterioration after debridemant surgery; 5) At final follow-up in lumbar tuberculosis, 60% of patients in the debridement group had 10$$ 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.

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