Surgical management of consecutive multisegment thoracic and lumbar tuberculosis: anterior-only approach vs. posterior-only approach

Abstract

Purpose: To compare the efficacy, safety, and technical characteristics of anterior-only and posterior-only approach surgeries for the treatment of consecutive multisegment thoracic and lumbar tuberculosis.

Methods: Thirty-five patients who developed consecutive multisegment thoracic and lumbar tuberculosis from September 2012 to May 2016 were retrospectively analyzed. Group A was the posterior-only surgery group, and group B was the anterior-only surgery group. The data on the surgery, deformity correction, functional scores, and complications were compared between the two groups.

Results: There was no significant difference in the operation time or blood loss between groups A and B (P > 0.05). The preoperative average Cobb angle of kyphosis in groups A and B were 36.2 ± 15.2° and 27.9 ± 7.7°, respectively, which significantly decreased to 4.9 ± 11.8° and 10.4 ± 5.6° after the operation, respectively (P < 0.05). At the final follow-up, the angles were 7.1 ± 10.5° and 14.6 ± 8.0°. The correction angle and correction rate in group A (31.3 ± 16.6°, 88.6 ± 43.6%) were greater than those in group B (17.5 ± 4.4°, 64.9 ± 14.0%) (P < 0.05). There was no significant difference in the loss angle between groups A and B (P > 0.05), but the loss rate in group B (24.0 ± 27.8%) was higher than that in group A (9.6 ± 10.2%) (P < 0.05). There was no significant difference in the incidence of complications between the two groups (P > 0.05).

Conclusion: The posterior-only and anterior-only approaches can lead to satisfactory clinical results in the treatment of patients with consecutive multisegment thoracic and lumbar tuberculosis. With posterior-only surgery, kyphosis can be better corrected, and the correction can be better maintained than with anterior-only surgery.

Keywords: Anterior-only approach; Consecutive multisegment; Deformity correction; Kyphosis; Posterior-only approach; Spinal tuberculosis.

Fig. 1

Case I. A 25-year-old male patient with T3–5 TB who was assigned to group A. a–f show the preoperative X-ray, CT, and MRI scans. The patient was treated with posterior-only surgery, and the internal fixation region was T3–6. g and h show the 1-week postoperative X-rays. i–l show the 2-year postoperative X-ray, CT, and MRI scans

Fig. 2

Case II. A 47-year-old male patient with L7–11 TB who was assigned to group B. a–f show the preoperative X-ray, CT, and MRI scans. The patient was treated with anterior-only surgery, and the internal fixation region was T8–11. g and h show the 1-week postoperative X-rays. i–l show the 2-year postoperative X-ray, CT, and MRI scans