Operation to produce surgical fusion of the spine is a comparatively safe procedure. It may be performed without danger of aggravating the disease process. It aids in giving stability to the diseased portion of the spine. It does not necessarily prevent extension of the disease, formation of abscess, irritation of the spinal cord, or paraplegia among patients whose resistance is not good. It is best to delay spine fusion for children who are sick; then, when the process becomes quiescent, spine fusion can be employed as an internal splint to aid in ankylosis. The results of spine fusion as a treatment for tuberculosis of the spine are probably better in adults than in children. An operation that produces fusion of the entire region of involvement gives better immobilization and, consequently, better results than does one that effects fusion of a more limited region. It is often impossible, in the early stages of tuberculosis of the spine, to determine the exact extent of the process either by clinical or by roentgenographic examination.
At the end of five years, 396 of our 480 patients had been traced; of these 396 patients, 63.64 per cent. had returned to an occupation, 7.83 per cent. had obtained improvement, 3.79 per cent. had had temporary improvement with relapse later, 6.31 per cent. had had no improvement, and 18.43 per cent. had died.
The best results are obtained when patients are carefully selected for operation, when spine fusion is employed during the period of healing of the disease, and when such treatment is reinforced by conservative treatment for a prolonged period of time.
The paramount requirement for every patient who has tuberculosis of the spine is rest, heliotherapy, and a nutritious diet. No surgical treatment can offset the value of conservative treatment.
(C) 1940 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.