Comparison Of The Clinical Efficacy By One Stage Anterior-only And Posterior-only Approaches Surgical Treatment Of Single-Segment Thoracic Spinal Tuberculosis

Objective: To explore the clinical efficacy of surgical treatment for singlesegment thoracic spinal tuberculosis with lesion removal,bone graft fusion,and screwrod internal fixation via one-stage anterior-only approach,by comparison with posterior-only approach.Methods:From June 2013 to September 2018,a total of 56 patients admitted to our hospital with single-segment thoracic spinal tuberculosis was collected to our retrospective study,divided into group A and group B according to different surgical methods;25 patients conducted with lesion removal,bone graft fusion,screw-rod internal fixation treatment via anterior-only approach(group A);31 patients conducted with lesion removal,bone graft fusion,and screw-rod internal fixation treatment via posterior-only approach(group B).Anti-tuberculosis drug treatment is routinely performed for 2 to 4 weeks before surgery,and surgery is usually performed when the symptoms of tuberculosis poisoning are alleviated.The operation time,intraoperative blood loss and hospital stay,ESR,CRP value,kyphosis Cobb angle,kyphosis correction angle,loss angle,correction rate,loss rate,VAS score,ASIA classification,implantation bone fusion time and surgical complications were observed and compared between two groups.Results:All 56 patients finished the operation successfully,and the follow-up time was 12 to 30 months,with an average of 22 months.There were no significant differences between the two groups in terms of ESR,CRP value,kyphosis Cobb angle,correction angle,correction rate,VAS score,ASIA classification and surgical complications before and after surgery(p>0.05).In terms of operation time,intraoperative blood loss and hospital stay,group A was less than group B,the difference was statistically significant(p<0.05).In terms of correction angle loss degree and loss rate,group A was larger than group B,the difference was statistically significant(p<0.05).There was no difference in bone graft fusion time between the two groups(p>0.05),but the bone graft fusion time in group A was slightly earlier than that in group B.During the follow-up period,the pain symptoms and nerve function of the two groups were significantly improved,and the kyphosis Cobb angle was effectively corrected.At the last follow-up,all patients' ESR,CRP and other laboratory indicators returned to normal.Both groups achieved osseointegration,and no internal fixation loosening,displacement,or rupture occurred.All patients were clinically cured and there were no relapses.Conclusion:Under the standardized treatment of anti-tuberculosis drugs,onestage anterior-only approach lesion removal,bone graft fusion,and screw-rod internal fixation surgical treatment of single-segment thoracic spinal tuberculosis can obtain the same clinical efficacy as the posterior-only approach.The operation time,intraoperative blood loss and hospitalization time of anterior-only approach are less than posterioronly approach,but in terms of long-term maintenance of kyphosis correction angle is not as good as posterior-only approach.