Clinical Efficacy Comparison Of One-stage Posterior And Combined Anterior-posterior Surgical Treatment For Spinal Tuberculosis

Objective:To investigate the clinical efficacy of one-stage posterior debridement,bone graft and internal fixation in the treatment of spinal tuberculosis,and compare it with combined anterior-posterior approach.Method:A total of 71 cases with spinal tuberculosis between January 2013 and April 2015 were reviewed retrospectively,of these,37 cases underwent one-stage posterior debridement, bone graft and internal fixation(single posterior group),including 17 males and 20 females with an average age of 46 years, the follow-up period ranged from 9 months to 21 months(mean14.1months).While another 34 cases experienced anterior debridement, bone graft and posterior internal fixation(combined anterior and posterior group),including 18 males and 16 females with an average age of 44 years,all cases were followed up for 8-22 months(average 13.8 months).After antituberculotic treating for 2~3 weeks in both groups of patients,the ESR,CRP,Cobb angle correction,intraoperative blood loss, operation time, hospitalization and ASIA grade before and after surgery and complication rates between each group were reviewed and compared.Result:In single posterior group, the average operation time was 196.67±16.92 min,the average intraoperative blood loss was 758.33±137.12 ml and the average hospitalization was9.85±1.17 d.While in combined anterior and posterior group,the average operation time was219.38±19.74 min,the average intraoperative blood loss was 1083.54±125.24 ml and the average hospitalization was 13.83±1.55 d,which showed the difference was statistically significant(P<0.05).After the operation,in single posterior group, the average ESR was 26.19±5.82mm/h,the average CRP was CRP13.63±2.79mg/L,the average Cobb angle correction was24.81±7.91°,While in combined anterior and posterior group,the average ESR was23.75±4.60mm/h,the average CRP was 12.29±1.85mg/L,the average Cobb angle correction was22.71±7.34°.There were no significant difference was noted with respect to ESR, CRP, ASIA grade and Cobb angle correction between two groups(P>0.05). 3 cases were found CSF leakage and 2 cases with delayed healing of the wound in single posterior group,while 2 cases with CSF leakage and 2cases occurred delayed healing in combined anterior and posterior group, all cases recovered well underwent active treatment.No complication such as tuberculosis recurrence andintenal fixation failure were observed.The difference of complication rates between two groups was not statistically significant(P>0.05).Conclusion:Either one-stage posterior debridement,bone graft and internal fixation or combined anterior-posterior approach treat spinal tuberculosis had satisfactory effect, however,the single posterior group have the advantages of less operation time, intraoperative blood loss and hospitalization.