SPINAL DEFORMITY AFTER CHILDHOOD SURGERY FOR TUBERCULOSIS OF THE SPINE - A COMPARISON OF RADICAL SURGERY AND DEBRIDEMENT

We have reviewed 80 children who were involved in the Medical Research Council (UK) trial of surgical treatment for tuberculosis of the spine in Hong Kong. Radical surgery or debridement had been performed at mean ages of 7.6 years (n = 47) and 5.1 Sears (n = 33) respectively. The patients were followed up to skeletal maturity (mean 17 years). Spinal deformity was measured on lateral radiographs taken preoperatively, at six months, one year, five years and at final follow-up. Radical surgery and grafting produced a reduction in kyphos and deformity angles at six months; this correction was maintained during the growth period. By contrast, after debridement surgery there was an increase in deformity at six months, with a tendency to some spontaneous correction during the growth period. There were statistically significant differences between angles for the radical and debridement groups only at six months postoperatively, but the changes during later follow-up were similar in the radical and debridement groups. Our findings highlight the importance of the surgical correction of deformity, and provide no evidence to suggest that disproportionate posterior spinal growth contributes to progression of deformity after anterior spinal fusion in children.