Comparison between single anterior and single posterior approaches of debridement interbody fusion and fixation for the treatment of mono-segment lumbar spine tuberculosis

Abstract

Purpose: To compare the efficacy of single anterior and single posterior approach of debridement, interbody fusion, and fixation for the treatment of mono-segment lumbar spine tuberculosis (TB) patients.

Methods: Eighty-seven patients with mono-segment lumbar TB who underwent debridement, interbody fusion, and fixation through either single anterior (Group A) or single posterior approach (Group B) from January 2007 to January 2017 were enrolled in this study. The duration of the operation, blood loss, complication rate, visual analog scale (VAS), Oswestry disability index (ODI), Frankel scale, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), kyphosis angle, correction rate, correction loss, and time taken for bone graft fusion were compared between the groups.

Results: The average period of follow-up was 34.3 ± 9.5 months (24-56 months). No significant differences were observed between patients in Group A and patients in Group B in terms of gender, age, body mass index (BMI), duration of illness and preoperative evaluative indices (P > 0.05). The mean operation time and blood loss was significantly higher in Group A (P = 0.000), along with a slightly higher rate of complications compared with Group B (P = 0.848). The VAS, ODI and Frankel scale scores showed significant improvement in both groups (P = 0.000), along with the ESR, CRP and kyphosis indices (P = 0.000), which were similar in both groups at the final follow-up.

Conclusion: Both single anterior and single posterior approaches of debridement, interbody fusion and fixation are effective for mono-segment lumbar TB patients, although the single posterior approach is of a shorter duration and results in less blood loss.

Keywords: Anterior; Lumbar; Mono-segment; Posterior; Spinal tuberculosis.

Fig. 1

Flow chart for patients enrolled

Fig. 2

A 73-year-old male patient with L2–3 mono-segmental spinal TB, who complained of severe back pain for 7 months, received single anterior debridement, interbody fusion and vertebral fixation. a, b Preoperative X-ray of AP and lateral images show lumbar degeneration and loss of L2-3 intervertebral height. c, d Preoperative CT and MRI images show the destruction of vertebral bodies and disc. e, f Postoperative X-ray of AP and lateral images show good position of vertebral screw fixation. g, h Postoperative CT images show solid interbody fusion had been achieved at the postoperative 24th month

Fig. 3

A 29-year-old male patient with L2–3 mono-segmental spinal TB, who complained of severe low back pain for 3 months, received single posterior debridement, interbody fusion and pedicle fixation. a, b Preoperative X-ray of AP and lateral images show roughly normal radiological presentation. c, d Preoperative CT and MRI images show the destruction of vertebral bodies and disc. e, f Postoperative X-ray of AP and lateral images show good position of pedicle screw fixation. g, h Postoperative CT images show solid interbody fusion had been achieved at the postoperative 24th month