The problem of deformity in spinal tuberculosis.

Spinal tuberculosis is the most common cause for a kyphotic deformity in patients in many parts of the world. There is an average increase of 15 degrees deformity in all patients who are treated conservatively and 3% to 5% of patients may end up with a deformity that is greater than 60 degrees. The progress of deformity occurs in two distinct phases: Phase I, which includes the changes in the active phase, and Phase II, which includes changes after the disease is cured. The progress of deformity is influenced by the severity of the angle before treatment, the level of the lesion, and age of the patient. Adults have an increase less than 30 degrees during the active phase with no additional change. Children, in contrast, have significant changes even in the healed phase of the disease. During the growth spurt, there is worsening of the deformity in 39% (Type I progression), an improvement in 44% (Type II), and no change in 17% (Type III). Children at risk of late progressive deformity can be identified early by the presence of spine-at-risk radiologic signs. Surgery for preventing deformity must be done earlier rather than later and in patients with severe disease, stabilization by the use of posterior and anterior instrumentation is necessary to obtain a good outcome.