Aims. To benchmark the radiation dose to patients during the course of treatment for a spinal deformity. Methods. Our radiation dose database identified 25,745 exposures of 6,017 children (under 18 years of age) and adults treated for a spinal deformity between 1 January 2008 and 31 December 2016. Patients were divided into surgical (974 patients) and non-surgical (5,043 patients) cohorts. We documented the number and doses of ionizing radiation imaging events (radiographs, CT scans, or intraoperative fluoroscopy) for each patient. All the doses for plain radiographs, CT scans, and intraoperative fluoroscopy were combined into a single effective dose by a medical physicist (milliSivert (mSv)). Results. There were more ionizing radiation-based imaging events and higher radiation dose exposures in the surgical group than in the non-surgical group (p < 0.001). The difference in effective dose for children between the surgical and non-surgical groups was statistically significant, the surgical group being significantly higher (p < 0.001). This led to a higher estimated risk of cancer induction for the surgical group (1:222 surgical vs 1:1,418 non-surgical). However, the dose difference for adults was not statistically different between the surgical and non-surgical groups. In all cases the effective dose received by all cohorts was significantly higher than that from exposure to natural background radiation. Conclusion. The treatment of spinal deformity is radiation-heavy. The dose exposure is several times higher when surgical treatment is undertaken. Clinicians should be aware of this and review their practices in order to reduce the radiation dose where possible. Cite this article: Bone Joint J 2021;103-B(4):1–7

Adolescent Idiopathic Scoliosis (AIS) patients were subjected to four weeks of Physiotherapy Scoliosis Specific Exercise (PSSE). 124 (Exclusion = 3) Patients were enrolled and assigned to either complete their treatment in one 4-week bout (4WC) (63 patients, M_age = 14.52), or to complete their treatment in two separate fortnightly bouts (2X2WC) (63 patients, M_age = 14.26). Clinical exam, surface topography and Scoliometer readings were compared. The SRS-30 questionnaire before and after treatment was conducted at 6, 12, 18 and 24 months.

Group 1 (4WC) showed significant improvements from baseline (Pre-3.73 – Post 3.9; p=0.026) after the course of treatment, and showed significant improvements at 12 months follow up in Mental Health (p=0.006), Aggregate score (p= 0.005) and Satisfaction score (p=0.011). Satisfaction score remained statistically significant at 18 months follow up (p=0.016). Group 2 (2X2WC) did not record a significant improvement from baseline (p=0.058); however, showed significant improvements in self-image (p=0.013). There was no statically significant difference in SRS scores with respect to follow up time.

We conclude that Physiotherapy Scoliosis Specific Exercise (PSSE) is a successful non-invasive therapy for AIS. The modified Schroth technique (ScolioGold) shows significant improvement in SRS30 scores with the 4-week intensive course that are sustained at a 2 year follow up.

Aims. People with severe, persistent low back pain (LBP) may be offered lumbar spine fusion surgery if they have had insufficient benefit from recommended non-surgical treatments. However, National Institute for Health and Care Excellence (NICE) 2016 guidelines recommended not offering spinal fusion surgery for adults with LBP, except as part of a randomized clinical trial. This survey aims to describe UK clinicians’ views about the suitability of patients for such a future trial, along with their views regarding equipoise for randomizing patients in a future clinical trial comparing lumbar spine fusion surgery to best conservative care (BCC; the FORENSIC-UK trial). Methods. An online cross-sectional survey was piloted by the multidisciplinary research team, then shared with clinical professional groups in the UK who are involved in the management of adults with severe, persistent LBP. The survey had seven sections that covered the demographic details of the clinician, five hypothetical case vignettes of patients with varying presentations, a series of questions regarding the preferred management, and whether or not each clinician would be willing to recruit the example patients into future clinical trials. Results. There were 72 respondents, with a response rate of 9.0%. They comprised 39 orthopaedic spine surgeons, 17 neurosurgeons, one pain specialist, and 15 allied health professionals. Most respondents (n = 61,84.7%) chose conservative care as their first-choice management option for all five case vignettes. Over 50% of respondents reported willingness to randomize three of the five cases to either surgery or BCC, indicating a willingness to participate in the future randomized trial. From the respondents, transforaminal interbody fusion was the preferred approach for spinal fusion (n = 19, 36.4%), and the preferred method of BCC was a combined programme of physical and psychological therapy (n = 35, 48.5%). Conclusion. This survey demonstrates that there is uncertainty about the role of lumbar spine fusion surgery and BCC for a range of example patients with severe, persistent LBP in the UK. Cite this article: Bone Jt Open 2024;5(7):612–620

Aims. The aim of this study was to determine whether early surgical treatment results in better neurological recovery 12 months after injury than late surgical treatment in patients with acute traumatic spinal cord injury (tSCI). Methods. Patients with tSCI requiring surgical spinal decompression presenting to 17 centres in Europe were recruited. Depending on the timing of decompression, patients were divided into early (≤ 12 hours after injury) and late (> 12 hours and < 14 days after injury) groups. The American Spinal Injury Association neurological (ASIA) examination was performed at baseline (after injury but before decompression) and at 12 months. The primary endpoint was the change in Lower Extremity Motor Score (LEMS) from baseline to 12 months. Results. The final analyses comprised 159 patients in the early and 135 in the late group. Patients in the early group had significantly more severe neurological impairment before surgical treatment. For unadjusted complete-case analysis, mean change in LEMS was 15.6 (95% confidence interval (CI) 12.1 to 19.0) in the early and 11.3 (95% CI 8.3 to 14.3) in the late group, with a mean between-group difference of 4.3 (95% CI -0.3 to 8.8). Using multiply imputed data adjusting for baseline LEMS, baseline ASIA Impairment Scale (AIS), and propensity score, the mean between-group difference in the change in LEMS decreased to 2.2 (95% CI -1.5 to 5.9). Conclusion. Compared to late surgical decompression, early surgical decompression following acute tSCI did not result in statistically significant or clinically meaningful neurological improvements 12 months after injury. These results, however, do not impact the well-established need for acute, non-surgical tSCI management. This is the first study to highlight that a combination of baseline imbalances, ceiling effects, and loss to follow-up rates may yield an overestimate of the effect of early surgical decompression in unadjusted analyses, which underpins the importance of adjusted statistical analyses in acute tSCI research. Cite this article: Bone Joint J 2023;105-B(4):400–411

Aims. The aims of this study were to determine the rates of surgical complications, reoperations, and readmissions following herniated lumbar disc surgery, and to investigate the impact of sociodemographic factors and comorbidity on the rate of such unfavourable events. Patients and Methods. This was a longitudinal observation study. Data from herniated lumbar disc operations were retrieved from a large medical database using a combination of procedure and diagnosis codes from all public hospitals in Norway from 1999 to 2013. The impact of age, gender, geographical affiliation, education, civil status, income, and comorbidity on unfavourable events were analyzed by logistic regression. Results. Of 34 639 operations, 2.7% (95% confidence interval (CI) 2.6 to 2.9) had a surgical complication, 2.1% (95% CI 2.0 to 2.3) had repeat surgery within 90 days, 2.4% (95% CI 2.2 to 2.5) had a non-surgical readmission within 90 days, and 6.7% (95% CI 6.4 to 6.9) experienced at least one of these unfavourable events. Unfavourable events were found to be associated with advanced age and comorbidity. Conclusion. The results suggest that surgical complications are less frequent than previously suggested. There are limited associations between sociodemographic patient characteristics and unfavourable events. Cite this article: Bone Joint J 2019;101-B:470–477

Background. The national back pain pathway sets out the gold standard pathway for patients with back and radicular pain. To improve implementation we needed to understand current practice and identify divergences from the pathway. Objectives. 1) What patient is referred into the surgical clinic?. 2) What treatments had they tried?. 3) How many had spinal interventions. 4) Consider ways to improve the appropriateness of referrals. Method. 100 new patients attending the Spinal Orthopaedic Clinic from December 2018 to February 2019 were asked to complete a questionnaire asking about previous interventions and benefit gained. Symptoms and outcomes were recorded from the clinical entries and MRI's reviewed. Results. Over 90 had tried analgesics with only 60 reporting more than 50% benefit. Only 6 had tried neuromodulators all with poor results. 82 attended physiotherapy with 62 reporting some benefit. 84 tried exercises and 31 found it helpful whereas 17 had acupuncture and 8 of those reported benefit. 65 had consistent findings on their MRI and 31 elected to have an intervention. 8 were better, 22 wanted to self-manage and 4 went to other providers. Conclusion. 82% of our patients had tried analgesics and physical therapy before being referred to secondary care. Few opted to have an intervention and could possibly have been managed in a non-surgical clinic. If appropriate training and management is put into primary care settings, secondary care referrals could be reduced. Only 1/3 of the patients were right patient right place right time. Conflicts of interest: No conflicts of interest. Sources of funding: No funding obtained

Purpose. To determine, for the first time, how back pain is portrayed in the United Kingdom press. Methods and Results. LexisNexisTM Professional search engine was utilised to retrieve articles from all national newspapers over a six months containing the terms “back pain/backpain/back ache/backache” from May to October 2009. 284 relevant articles were retrieved. Of these tabloids accounted for 62% and broadsheets for 38%. Back pain was the sole topic in 7%, a main topic in 18% and mentioned in passing in 75%. 15% were essentially case reports and the tone was neutral in 95%, positive in 2.5% and negative in 2.5%. The cause of back pain was mentioned in 11% of articles- trauma accounted for 50% and disc disease and spinal deformity for 20% each. Only 0.3% of articles discussed litigation. Articles mentioned new physiotherapy regimes in 7%, new forms of alternative therapy in 7%, new surgical techniques/technologies in 2% and new medications in 1%. They were significantly more likely to mention new non-surgical techniques- Fishers' Exact Test p=0.01. Articles were alternative therapy related in 3%, physiotherapist related in 2%, surgeon related in 1% and pain specialist related in 1%. 10% of papers included a quote from an “expert” of which 23% were Spine Surgeons, 16% GP's, 13% Sports Physicians, 13% alternative therapists, 10% pain specialists and 7% physiotherapists. Overall, 98% of articles were of a neutral tone and 1% were of a positive tone or negative tone. Articles concerning physiotherapists or new surgical techniques/technologies were significantly more likely to be of a positive overall tone than the other articles- Fishers' Exact Test p=0.04. Conclusions. Back pain receives a considerable amount of attention in the United Kingdom press. Much of this currently concentrates on isolated case reports, the aetiology of back pain is poorly represented, quoted “experts” are frequently non-medical and new surgical treatments receive significantly less attention than new non-surgical treatments. The press play an important role in educating and informing the general public. The stories they cover ad how they cover them have a powerful influence on public perceptions. We need to do more to engage with the press and positively influence their reportage

Aims

Gram-negative infections are associated with comorbid patients, but outcomes are less well understood. This study reviewed diagnosis, management, and treatment for a cohort treated in a tertiary spinal centre.

Aims

The aim of the study was to determine if there was a direct correlation between the pain and disability experienced by patients and size of their disc prolapse, measured by the disc’s cross-sectional area on T2 axial MRI scans.

Purpose and background:. MRI findings associated with spondyloarthritis (SpA) can be difficult to distinguish from the more prevalent findings of degeneration. Despite this, the two groups of MRI-findings are often evaluated in separate studies and in different study populations, which may reduce their applicability in daily clinical practice. The purpose of this study was to estimate the prevalence of degenerative and SpA related MRI-findings in the spine and sacroiliac joints (SIJ) in patients with persistent LBP. Methods:. Patients with persistent LBP (n=1037, median age 33 [IQR 27–37], 54% women) referred to an outpatient, secondary care and non-surgical department were included in the study. MRI of the whole spine and the SIJ was performed and degenerative and SpA-related MRI-findings were evaluated by experienced musculoskeletal radiologists. Results:. The prevalence of disc degeneration, disc contour changes, and Modic changes were 87%(±1.1), 82%(±1.2) and 48%(±1.6). All degenerative spinal findings were most frequent in men and patients aged 30–40 years. Spinal SpA-related MRI-findings were rare. In the SIJ, 28%(±1.4) had at least one MRI finding, with bone marrow oedema (BMO) being the most common (21%(±1.3)). SIJ erosions were most prevalent in patients aged 18–29 years and BMO in patients aged 30–40 years. SIJ sclerosis and fatty marrow deposition were most common in women. Post hoc analysis showed that SIJ BMO, sclerosis and erosions were most frequent in women indicating pregnancy-related LBP. Conclusion:. The high prevalence of SIJ MRI findings associated with age, gender, and pregnancy-related LBP need further investigation of their clinical importance in patients with persistent LBP

Introduction. There has been a recent surge in the interest of the role of vitamin D in chronic musculoskeletal pain however there are limited studies that have investigated the link of vitamin D hypovitaminosis with low back pain. The aim of our study was to determine the prevalence of low vitamin D levels in patients who present with low back pain in an outpatient setting in the UK. Methods. Data was collected retrospectively from computerised databases of all patients who presented with low back pain from a single spinal consultant's outpatient clinic and have had serum levels of 25-hydroxycholecalciferol (25-OH vitamin D) requested. Data of these patients were collected from hospital electronic and paper records and analysed against their serum 25-OH vitamin D levels. Results. Data on 229 patients was collected over an 18 month period. 19.7% of patients presenting to the spinal outpatient clinics had severe 25-OH vitamin D deficiency (less than 15 nmol/L) compared to 2.6% of 3132 non-spinal outpatient clinic patients (p<0.001). However, the percentage of patients with deficient (15 to 30 nmol/L) but not severe deficiency was similar in both groups (37.6% versus 38.3%). There was no significant difference in the incidence of vitamin D deficiency whether a surgical or non-surgical pathology was present or not (p=0.62). Conclusion. We have found no link between vitamin D deficiency and low back pain in this study. Vitamin D deficiency is a common comorbidity in Leicester

To quantify the duration of symptoms and the treatment modalities employed prior to surgery in patients undergoing lumbar and cervical nerve root decompression and to assess the evidence of these non-surgical treatments. Pre- and post operative questionnaires completed by consecutive patients. 514 people undergoing consecutive cervical or lumbar nerve root decompression between March 2007 to October 2009. Pre-operative severity and duration of pain, functional limitations and treatment received. Post-operative pain severity and change in functional limitations. Evidence in the literature for efficacy of treatment modalities employed. Mean duration of pre-operative symptoms was 23 months (range 1 to 360). 91% took regular medication for pain, 83% received one or more physical therapy, 24% received injection therapy. There was improvement in both pain scores (mean pre-op 7.3; post-op 3.0) and 78% of the commonly reported functional limitations, walking, sleep and work. We found extremely limited evidence to support the other treatment modalities employed. Patients spend many months unnecessarily in pain, consuming considerable resources and may suffer significant side effects from ineffective treatment for pain emanating from nerve root compression. Surgical nerve root decompression relieves pain and restores function. Despite this a specialist opinion is often delayed. Early referral for specialist opinion is almost certainly more humane, cost effective, and time-limits the journey on the not so magic roundabout

Aim. To identify patterns in referral and the management pathway of patients with primary bone tumours of the spine referred to the Orthopaedic Spine Unit in order to recommend ways to improve the service. Methods and Results. A retrospective notes and imaging review to evaluate the referral pathway undertaken by patients ending up in the orthopaedic spine unit over a 5 year period according to the recommendations for primary bone tumours. Significant events leading to potential improvement in outcomes were assessed. Recommendations for improvements are suggested. None of the 38 patients evaluated were referred within two weeks of presentation, and only 6 were referred directly to the bone tumour service. Almost half (15/32) of the patients who had an indirect referral pathway had a prior intervention. Five of these had non-surgical, while 10 had surgical interventions outside the tumour centre before their referral. Of these, seven had malignant tumours. Conclusion. In order to optimise outcome, patients with potentially malignant primary tumours of the spine should be referred directly to tumour services. Prior procedures should be limited to biopsy procedures and discussed with the tumour service before this is undertaken having appropriate investigation and imaging available. Guidelines for this should be directed at streamlining the referral pathway and encouraging communication between stakeholders. Further research should assess the impact of patient-related delay in presentation contributes to overall delay in referral to tumour service; how early radiological assessment may augment timely referral; and how indirect referral and prior intervention affect patient outcomes

Patients with neurogenic claudication from lumbar canal stenosis non-responsive to non-surgical treatment are usually managed with spinal decompression with or without fusion. Flexion at stenotic segments relieves symptoms by increasing canal cross-sectional area, intervertebral foraminal height. Interspinous spacers work by causing flexion at the treated segement. We used COFLEX¯ [Paradigm Spine] a titanium interspinous spacer along with interlaminar decompression where indicated. To compare the clinical and radiological results of patients undergoing interlaminar decompression with or without use of COFLEX¯. Pre and post-operative assessment and comparison of clinical outcomes of Oswestry disability index(ODI), Visual analog Scale(VAS), Short Form-36(SF-36) and radiological outcomes of disc heights of operated and adjacent levels, intervertebral foraminal heights, sagittal angles of the operated segment. All consecutive patients undergoing spinal decompression at one or more levels from Jan to Dec 2008 were included. Patients with clinically symptomatic back pain for a duration longer than claudication pain were offered interspinous spacer at L4/5 level or above. In first group(n-20), patients were treated with inter-laminar decompression and COFLEX¯ with a standard posterior approach. In second group(n-25) inter-laminar decompression for the involved segment was performed. All patients are on follow-up. Clinical and radiological outcomes were compared at 6 months and 1 year. Statistically significant(p<0.001) improvements in ODI, VAS(back), VAS(leg) and SF-36 in patients in whom COFLEX¯ was used. Radiological parameters also showed significant improvements(p<0.05). Use of COFLEX¯ spacer is justified in patients with symptomatic disc degeneration with neurogenic claudication when treated operatively

Purpose. Patients with ankylosing spondylitis (AS) are vulnerable to cervical spine injury following relatively minor trauma. The authors present a retrospective review to determine the characteristics, treatment and outcome following cervical spine injury in these patients. Methods. Retrospective analysis of case notes and images of patients with AS admitted to the Spinal Injury Unit over a 10-year period. Results. Thirty-nine patients were identified. Records were available for 31 patients at the time of this analysis. The median age was 62 years (range 37-84). The male:female ratio was 7:1. Mechanisms of injury included falls (72%) and RTAs (7%), while 14% were unable to recall an injury. Alcohol was involved in 20% of the cases. Fracture through an ankylosed disc in the mid to low cervical spine was the commonest injury. Concomitant non-contiguous bony injury was seen in 2 patients. More than half (55%) were Grade E on ASIA impairment scale (AIS), while 14% were Grade A and 31% Grade D. Two patients required skull traction. Most patients were successfully treated by external immobilisation. Halo crown and jacket was the most common orthosis used. Twelve patients underwent surgical stabilisation. The mean duration of external immobilisation in the non-surgical group was 13 weeks (range 10-32), whereas following surgery it was 6 weeks (range 2-8). Adequate radiological evidence of fusion was seen in all 22 patients for whom this information was available at a median of 22 weeks (range 12-32). Patients with AIS Grade A and E were unchanged at discharge, while 4 patients in AIS Grade D improved to E. Conclusion. External immobilisation with halo in an effective first-line therapy in achieving fusion and stability. Surgical stabilisation can be reserved as a second-line treatment

Purpose. Patients with ankylosing spondylitis (AS) are vulnerable to cervical spine injury following relatively minor trauma. The authors present a retrospective review to determine the characteristics, treatment and outcome following cervical spine injury in these patients. Methods. Retrospective analysis of case notes and images of patients with AS admitted to the Spinal Injury Unit over a 10-year period. Results. Thirty-nine patients were identified. Records were available for 31 patients at the time of this analysis. The median age was 62 years (range 37-84). The male:female ratio was 7:1. Mechanisms of injury included falls (72%) and RTAs (7%), while 14% were unable to recall an injury. Alcohol was involved in 20% of the cases. Fracture through an ankylosed disc in the mid to low cervical spine was the commonest injury. Concomitant non-contiguous bony injury was seen in 2 patients. More than half (55%) were Grade E on ASIA impairment scale (AIS), while 14% were Grade A and 31% Grade D. Two patients required skull traction. Most patients were successfully treated by external immobilisation. Halo crown and jacket was the most common orthosis used. Twelve patients underwent surgical stabilisation. The mean duration of external immobilisation in the non-surgical group was 13 weeks (range 10-32), whereas following surgery it was 6 weeks (range 2-8). Adequate radiological evidence of fusion was seen in all 22 patients for whom this information was available at a median of 22 weeks (range 12-32). Patients with AIS Grade A and E were unchanged at discharge, while 4 patients in AIS Grade D improved to E. Conclusion. External immobilisation with halo in an effective first-line therapy in achieving fusion and stability. Surgical stabilisation can be reserved as a second-line treatment

Purpose. This study aims to identify factors that influence the Cobb angle at presentation to a tertiary referral scoliosis centre, and the outcome of the referrals. Methods. 81 consecutive patients referred were reviewed retrospectively. Hospital database, clinic letters and radiographs were examined. Patient demographics, mode of referral (GP vs. tertiary), severity and type of scoliosis were recorded. The season of referral was defined as ‘warm’ between months of June and September, and ‘cold’ between November and March. Cobb angle measurements were made independently on digital radiographs by 2 Orthopaedic trainees. Results. There were 60 females and 21 males referred. Of these patients, 31 (38%) were offered surgery. The overall mean Cobb angle was 43° (SD 22.5°), where the surgical group was 58° (SD 20°) and the non-surgical group was 33° (SD 18°), p < 0.05. The mean age of the patients for surgery was 22, compared to 19 in the non-operative group (p < 0.05). There was no significant influence of sex, season of referral, and mode of referral on operations offered. Males had a higher mean Cobb angle (52°) than female (39°) with marginal significance (p = 0.09). Advancing age correlated with increasing Cobb angle (r = 0.2, p = 0.09) with marginal significance. No other factors influenced the presenting Cobb angle. There was excellent inter-observer agreement in the Cobb angle measurements (α = 0.99). Conclusion. High Cobb angle and age were the only significant predictors for requirement of surgery in a tertiary referral scoliosis centre. Secondary or tertiary referral did not influence the severity or the outcome of patients with scoliosis. This may imply that GP direct referrals to scoliosis centres are sufficient, especially if Cobb angle measurements and age are included in the criteria. Seasonal differences in scoliosis presentation were not found, however further comparison can be made with countries with warmer climate to demonstrate the cosmetic influence. Ethics Approval: none. Interest Statement: none

Introduction. One of the most complicated problems of orthopaedics is the treatment of scoliosis. More than 90% of cases are attributable to idiopathic deformation, the cause of which is unknown. We investigated the cause and pathogenesis of this disorder. Methods. At our institution, more than 6900 patients aged 1–89 years have undergone inpatient and outpatient treatment in connection with spinal pain syndrome and different neurological disorders associated with idiopathic scoliosis. This study was undertaken between February, 1996, and February, 2010. All patients had had clinical, radiographic, and laboratory examinations. Results. 29·6% of patients were aged 31–50 years; 60% were men and 40% women. While examining patients with scoliosis deformation we noted symptoms of body asymmetry–ie, different volumes of right and left halves of face, body, and limbs. These features were typical for all patients irrespective of sex, age, and ethnic origin. 83·2% of patients had underdevelopment of left part of the body, and only 16·8% the right side. Analysis of published work in anatomy, physiology, neurophysiology, and vertebrology, done simultaneously with analysis of clinical material, allowed us to make some conclusions. Conclusions. First, asymmetrical structure of human body is based on laws of nature and is linked with difference of sizes and activity of brain's hemispheres, particularly of right or left gyrus centralis anterior, which control the muscle's function and our movements. Second, asymmetrical tension of Erector spinae muscles leads to inclination of the pelvis on a side of weak muscles; thus initiating development of lateral spine curves. Since such a situation is typical for all people, this deformation is known as functional scoliosis. Third, further development of bodies of vertebrae, their arches, processes, intervertebral discs, ligaments, and other anatomical elements in position of deviation leads to one-sided underdevelopment of these structures. As a result, areas of instability appear in each segment of spine (neck, chest, lumbar, and sacral areas). Fourth, the muscles in a growing body misbalance and on the ground of rotating movement start rotatory dislocation of vertebrae in zones of instability in all parts of the spine. As a result, torsion of deformed wedge-shaped vertebrae leads to formation of structural scoliosis. Rotation of vertebrae, described above, does not depend on sex, age, and ethnic origin of a patient and has a character of natural development. Thus, from our point of view, the term idiopathic scoliosis must be changed to spinal muscle asymmetrical deformation of a reflex origin. Understanding of this rotation allowed us to establish an effective non-surgical method of treatment of scoliosis and spinal pain syndrome in patients of all ages

Aims

Magnetically controlled growing rods (MCGR) have been gaining popularity in the management of early-onset scoliosis (EOS) over the past decade. We present our experience with the first 44 MCGR consecutive cases treated at our institution.

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To address the natural history of severe post-tuberculous (TB) kyphosis, with focus upon the long-term neurological outcome, occurrence of restrictive lung disease, and the effect on life expectancy.