Clinical Comparison Of The Anterior And The Antero-posterior Approaches For Lumbosacral Tuberculosis

Objective:The purpose of this study was to compare the clinical efficacy of the anterior and the antero-posterior approaches for lumbosacral tuberculosis, To investigate the feasibility, indications, the advantages and disadvantages of the anterior approach in the treatment of lumbosacral tuberculosis.Methods:From January2009to June2013, total45patients with lumbosacral tuberculosis were treated by using anterior approach or the antero-posterior approach.26of them were used the anterior approach(group A). There were16males and10females with the average age of40.5years-old. L4-L5was involved in12patients, L5in4patients,L5-S1in9patients and L4-S1in1patients. The remaining were used the antero-posterior approach(group B), There were9males and10females with the average age of39.3years-old. L4-L5was involved in5patients, L5-S1in10patients, L4-S1in3patients and L5-S2in1patients. All patients were managed by standard course of chemotherapy. The hospital stays,the operative time,blood loss,hospitalization expenses, ESR, lumbosacral angle, the grade of JOA, fusion status were compared. Result:All patients were followed up for9-60months (average25.4months).In the group A,the average operative time was174mins, the average blood loss was869ml. The average hospitalization was29thousands yuan. The average hospital stays was20days. In the group B,the average operative time was221mins. The average blood loss was968ml. The average hospitalization expenses was37thousands yuan. The average hospital stays was18days. There are statistical significance between the two group in the operative time,hospital stays(P<0.05),No statistical significance in blood loss and hospital stays(P>0.05). The average lumbosacral angle of the preoperative were30.8±8.4°(group A)and29±12.9°(group B),and at the late follow up were37±7.6°(group A) and34±5.5°(group B).Each group had the statistical significance between preoperative and the late follow up(P<0.05). There are no statistical significance in the lumbosacral angle difference in the two groups. The average ESR of the preoperation were46.27±27.76mm/h (group A) and9.19±3.21mm/h (group B), and at the last follow up were49.79±25mm/h (group A) and9.26±2.35mm/h (group B).the ESR of both groups were restored to the normal range. There are no statistical significance between the two group in clinical effects. The average fusion time were6.4±1.13months (group A) and7±1.07months (group B). Both groups had reach bone-graft fusion in the last follow up.Conclusion:The anterior and the antero-posterior approaches are both effective to treat lumbosacral tuberculosis. But the anterior approach is better than the antero-posterior approach in the operative time, hospitalization expenses.