Comparative Efficacy Of Anterior And Antero-posterior Approaches In Lumbar Tuberculosis Patients

Objective: To evaluate the clinical efficacy of debridement and bone grafting with internal fixation via the anterior approach and one-stage surgery via a combined anterior-posterior approach to provide a reference for selection of surgical options for patients with spinal tuberculosis by comparing the results of these two surgical approaches in the treatment of spinal tuberculosis.Methods: A systematic review was conducted in 118 patients with thoracolumbar spinal tuberculosis who underwent either debridement and bone grafting with internal fixation via the anterior approach(57 cases) or one-stage surgery via a combined anterior-posterior approach(61 cases) in Qinghai People’s Hospital between January 2012 and December 2013: patients receiving one of these two surgical procedures were randomly sampled from these patients and allocated to Group A(40 cases, debridement and bone grafting with internal fixation via the anterior approach) or Group B(40 cases, one-stage surgery via a combined anterior-posterior approach) and the changes in intraoperative blood loss, operative time, hospital stay, neurological function, erythrocyte sedimentation rate(ESR) and Cobb angle were analyzed statistically.Results: The mean intraoperative blood loss was 473.6±114.2 ml in Group A and 745.2±112.5 ml in Group B; the mean operative time was 145.2±21.4 min in Group A and 227.4±48.3 min in Group B; the mean hospital stay was 17.4±5.2 d in Group A and 22.5±4.7d in Group B. 30 patients in Group A and 33 patients in Group B were diagnosed with dysfunctions, and 27 patients in Group A and 31 in Group B exhibited functional improvement after surgery. The mean ESR was increased from 35.6±15.2 mm/h to 44.1±22.6 mm/h in Group A and from 31.9±16.8 mm/h to 52.6±23.9 mm/h. The Cobb angle was decreased from 35.2±11.5° to 19.6±13.3° in Group A and from 37.2±11.3° to 11.6±6.4° in Group B. Inter-group analysis showed statistically significant differences in intraoperative blood loss, operative time, hospital stay, and correction of Cobb angle(P<0.05) but not in changes of ESR(P>0.05) between two groups; the intra-group analysis showed that the preoperative ESRs were statistically different to the postoperative ones(P<0.05).Conclusion: Both debridement and bone grafting with internal fixation via the anterior approach and one-stage surgery via a combined anterior-posterior approach can effectively remove the lesion and correct deformity, but the later has advantages in correcting kyphosis and preventing the loss of Cobb angle.