***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Study Design . A 15‐year clinical follow‐up of tuberculous lesions of the lumbosacral region . Objectives . To verify the hypothesis that the lumbar lordosis and the specific biomechanics of the lumbosacral region influence and alter the healing pattern and progress of the disease when compared with their effects in other regions of the spine . Summary of Background Data . An estimated 2 million or more patients have active spinal tuberculosis , and the global incidence of the disease is increasing . The involvement of the lower lumbar region and the lumbosacral junction is relatively rare , with few reports in English literature . Methods . Of a total of 304 patients forming a part of a controlled clinical trial comparing two forms of therapy in spinal tuberculosis , 53 patients had involvement of L3 and below . The following data were studied in these patients : age at start of treatment , number of vertebra involved , vertebral body loss , progress of the angle of kyphosis , and anterior and posterior growth of the involved segment during a period of 15 years . Student 's t test for independent sample s was used for statistical analysis . Results . The fourth lumbar vertebra was the most common vertebral segment involved , and the lumbosacral junction was affected in 12 patients . The average pretreatment kyphosis was 6.4 ° and increased to 10.2 ° at the end of 15 years . The average kyphotic angle per vertebral body loss was 4.9 ° , far less than in the dorsolumbar region in which kyphotic angles of 27‐30 ° have been reported . Children younger than 10 years old differed in clinical appearance and progress compared with those older than 17 years . They not only showed more extensive involvement but also had more deformity with the same vertebral loss . Twelve patients less than 10 years old had an average involvement of 3.1 vertebral bodies and an average vertebral loss of 2.2 bodies . In comparison , the average number of vertebrae involved was 1.9 ( P < 0.01 ) and the vertebral body loss was only 0.87 ( P < 0.01 ) in patients older than 17 years . Also , the average kyphosis was 6.4 ° compared with only 4.2 ° ( P < 0.01 ) in adults . In patients older than 17 years , there was no change after 2 years , by which time the collapse was complete . Four of 12 patients less than 10 years old , showed progressive kyphosis caused by continued growth of posterior parts of the body ( i.e. , sequestrated hemivertebrae ) . Conclusions . In tuberculosis of the lumbosacral region , the development of kyphosis is minimal in patients older than 17 years , when growth has already stopped , and deformity is expressed more as foreshortening of the trunk . Children younger than 10 years old have more severe involvement with increased tendency toward greater kyphosis . They are also prone to progressive deformity through the years when the anterior growth plates are destroyed . Surgery is indicated in this group to prevent greater deformity The final results up to 15 years are reported of clinical trials of the management of tuberculosis of the spine in Korea and Hong Kong . In Korea , 350 patients with active spinal tuberculosis were r and omised to ambulatory chemotherapy or bed rest in hospital ( in Masan ) or a plaster-of-Paris jacket for nine months ( in Pusan ) . Patients in both centres were also r and omised to either PAS plus isoniazid for 18 months or to the same drugs plus streptomycin for the first three months . In Hong Kong , all 150 patients were treated with the three-drug regime and r and omised to either radical excision of the spinal lesion with bone graft or open debridement . On average , the disease was more extensive in Korea , but at 15 years ( or 13 or 14 years in a proportion of the patients in Korea ) the great majority of patients in both countries achieved a favourable status , no evidence of CNS involvement , no radiological evidence of disease , no sinus or clinical ly evident abscess , and no restriction of normal physical activity . Most patients had already achieved a favourable status much earlier . The earlier results of these trials are confirmed by the long-term follow-up with no late relapse or late-onset paraplegia . The results of chemotherapy on an outpatient basis were not improved by bed rest or a plaster jacket and the only advantage of the radical operation was less late deformity compared with debridement . A second series of studies has shown that short-course regimes based on isoniazid and rifampicin are as effective as the 18-month regimes : ambulatory chemotherapy with these regimes should now be the main management of uncomplicated spinal tuberculosis We performed a r and omised , controlled clinical trial to compare ambulant short-course chemotherapy with anterior spinal fusion plus short-course chemotherapy for spinal tuberculosis without paraplegia . Patients with active disease of vertebral bodies were r and omly allocated to one of three regimens : a ) radical anterior resection with bone grafting plus six months of daily isoniazid plus rifampicin ( Rad6 ) ; b ) ambulant chemotherapy for six months with daily isoniazid plus rifampicin ( Amb6 ) ; or c ) similar to b ) but with chemotherapy for nine months ( Amb9 ) . Ten years from the onset of treatment , 90 % of 78 Rad6 , 94 % of 78 Amb6 and 99 % of 79 Amb9 patients had a favourable status .  Ambulant chemotherapy for a period of six months with daily isoniazid plus rifampicin ( Amb6 ) was an effective treatment for spinal tuberculosis except in patients aged less than 15 years with an initial angle of kyphosis  of more than 30 degrees whose kyphosis increased substantially Of 112 patients who entered the Medical Research Council 's prospect i ve 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 Twenty-six of 95 adults treated for tuberculous spondylitis , between 1982 and 1993 , underwent surgery .  Twenty-one exhibited neurological deficits : radicular deficits : 4 , and progressive spinal cord syndromes : 17 ( incomplete , 13 , complete , of acute onset : 4 ) . Vertebral body compression fracture was the most prominent finding . Indications for surgery were neurologic : 11 , mechanical : 1 , etiologic : 1 , and mixed : 13 . Twelve patients had vertebrectomies , 3 laminotomies and 11 laminectomies . The average follow-up was 23 months . The neurological recovery was complete in 16 cases , partial in 4 cases and unchanged in one case . Bony consolidation occurred after 3 - 5 months . The medicosurgical treatment produced a very high cure rate , so rapidly , that it became the treatment of choice in our setting . Moreover , that allows to specify the diagnosis . Anterior decompression and fusion is recommended in the cervical and lumbar spine . In the thoracic segment , significant kyphosis is infrequent , so that surgical correction is rarely necessary . Laminotomy may occasionally be indicated for posterior decompression for abscess . Laminectomy is now preferred for uncommon cases of thoracolumbar posterior compression by tuberculous arachnoiditis or associated posterior vertebral tuberculosis . Indications for open biopsy are discussed A comparative analysis of the short and long-term results of two surgical procedures , radical excision or debridement , for the management of spinal tuberculosis in children is reported . Eighty children ( 47 treated with radical surgery and 33 with debridement ) ware prospect ively studied end followed to maturity ( mean follow-up . 17 years postoperatively ) . The kyphus and deformity angles were measured from lateral spinal radiographs using an electronic digitizer . The results can be summarized as follows : 1 ) Long-term clinical outcome off the two surgical procedures were equally good for recovery of neurologic deficit and relief of pain . There was no incidence of reactivation and /or recurrence of tuberculous lesion in either group ; 2 ) This mean changes in kyphus and deformity angles at the 6-month postoperative evaluation compared to their preoparative value ware significantly different for the two surgical groups , There was an overall correction in these angles after radical surgery , where as there was a deterioration after debridement surgery;3 ) There were no significant differences in the changes in kyphus or deformity angles at final follow-up from their 6-month postoperative measurements between the two surgical groups ; 4 ) The majority of children ( 56 % ) showed an Improvement in deformity angle of 6$$ or more after radical surgery at the 6-month postoperative evaluation , where as 69 % of children showed deterioration after debridemant surgery ; 5 ) At final follow-up in lumbar tuberculosis , 60 % of patients in the debridement group had 10$$ or more kyphus angle , whereas only one patient in the radical group had a kyphotic lumbar spine due to graft failure . In conclusion , the status of deformity achieved after surgery ( 6 months ) is important because it is virtually maintained up to final follow-up Of 112 patients who were subjects of the Medical Research Council 's prospect i ve study , 105 ( 94 % ) were involved in a longitudinal study follow-up for a mean of 15.3 years postoperatively . Seventy-one patients had radical resection of the tuberculous lesion and bone grafting , and the remaining 34 were treated with debridement surgery at a mean age of 36.7 and 35.3 years , respectively . All these patients were aged 18 years or older at the time of surgery . The kyphosis and deformity angles were measured on lateral spinal radiographs using an electronic digitizer . The results can be summarized as follows : ( 1 ) Neurologic recovery in both radical and debridement surgical groups were equally good and no patient had pain two years after surgery . There was no incidence of reactivation or recurrence of tuberculosis in either surgical group . ( 2 ) At the six-month postoperative evaluation , patients who had radical surgery showed marginal correction in deformity , whereas those who were treated with debridement showed deterioration in both kyphosis and deformity angles . There was a statistically significant difference between the two surgical groups for the mean changes in kyphosis and deformity angles at the six-month postoperative evaluation compared with their preoperative evaluation . ( 3 ) The mean difference for kyphosis and deformity angles at final follow-up evaluation from the patients ' six-month postoperative measurements were not statistically significantly different between the two surgical groups . ( 4 ) Forty percent of patients showed an improvement in deformity angle by 5 degrees or more after radical surgery at the six-months postoperative evaluation , whereas 53 % of patients showed deterioration after debridement surgery . ( 5 ) All patients with tuberculosis of the lumbar spine treated with radical surgery had normal lordosis in the lumbar spine at final follow-up evaluation , compared with only 63 % of patients after debridement surgery . Correction achieved after surgery at the six-month evaluation was practically maintained up to final follow-up evaluation . Radical resection and bone grafting provided better correction of deformity than did debridement surgery Study Design . A prospect i ve study on spinal tuberculosis conducted at Fauji Foundation Hospital , Rawalpindi , Pakistan , with 1 year of follow-up . Objective . The main aim was to diagnose spinal tuberculosis on clinical grounds and with simple noninvasive laboratory and radiology investigations and to treat the patients with antituberculosis drugs .  Summary of Background Data . Spinal tuberculosis associated with any neuro deficit is usually treated by surgery . Medical treatment can reverse most of the neuro deficit . Surgery should not be the first choice of treatment . Methods . Twenty-six patients with spinal tuberculosis were clinical ly diagnosed , were started on antituberculosis treatment , and were followed up for 12 months . Results . Backache is the most common symptom . Thirty-eight percent of patients presented with neuro deficit in the form of paraplegia and quadriplegia . Erythrocyte sedimentation rate was high in 100 % cases . Plain radiograph diagnosed the disease in 88.27 % patients . Eighty-five percent of cases completely improved on medical treatment without any surgical intervention . Conclusion . Uncomplicated spinal tuberculosis is a medical problem . The study shows that surgical intervention is not always necessary OBJECT The aim of this study was to evaluate conservative medical management of 44 patients with P 
    Output:
    
There were no significant between-group differences in kyphosis angle , bony fusion , bone loss or development of neurological deficit .
Conclusions There is no obvious statistically significant clinical precedence to suggest that routine surgery will improve the prognosis of patients with spinal tuberculosis