Longitudinal changes in spinal deformity after anterior spinal surgery for tuberculosis of the spine in adults. A comparative analysis between radical and debridement surgery.

Of 112 patients who entered the Medical Research Council's prospective study on the surgical management of spinal tuberculosis, 105 were available for review at a mean follow-up of 15.3 years postoperatively. All these patients were age 18 years or more at the time of surgery. Seventy-one patients had radical surgery; the remaining 34 underwent debridement surgery. The longitudinal changes in spinal deformity were evaluated using kyphus and deformity angles from lateral spinal radiographs obtained at preoperative evaluation, postoperatively at 6 months, 1 year, and 5 years, and at final follow-up. The mean kyphos and deformity angles showed correction after radical surgery at 6 months' evaluation; thereafter there were minimal variations up to final follow-up. Those who underwent debridement surgery showed an increase in these angles at 6 months postoperative evaluation; thereafter there were practically no changes in thoracic and thoracolumbar tuberculosis, whereas in lumbar tuberculosis there was spontaneous correction from 1 year post-surgery onward. The changes in mean kyphos and deformity angles at 6 months postoperative evaluation from their preoperative values were significantly different between the two surgical groups, where radical surgery produced better correction. Thus, the choice of surgery--radical or debridement--is important in determining the fate of spinal deformity in the management of tuberculosis of the spine.