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| CUI Xu,MA Yuanzheng,CHEN Xing.Selection and outcome of anterior vs posterior approach for spinal tuberculosis[J].Chinese Journal of Spine and Spinal Cord,2011,(10):807-812. |
| Selection and outcome of anterior vs posterior approach for spinal tuberculosis |
| Received:June 30, 2011 Revised:August 25, 2011 |
| English Keywords:Spinal tuberculosis Surgery treatment Choice of operation methods Outcome |
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| English Abstract: |
| 【Abstract】 Objective：To investigate the surgical procedures and their outcomes for spinal tuberculosis（TB） in adults.Method：Between January 2004 and December 2009，241 adult patients with thoracolumbar and lumbosacral TB undergoing different surgical procedures were reviewed retrospectively.A total of 181 patients with multiple-level continuous spinal TB were followed up for 22-72 months（mean，37 months）.Of 25 patients with neurological deficit，there were 14 Frankel D and 11 Frankel C.The involved vertebrae included 4 continuous vertebrae in 11（thoracic），3 continuous vertebrae in 45，2 continuous vertebrae in 98，and 1 vertebra in 27 cases.It showed obvious defect in 132 patients and paraspinal abscess in 153 cases by CT and MRI examination.The kyphosis Cobb angle ranged from -23° to 30° in 104 cases，31° to 60° in 49 cases and 61° to 70° in 28 cases.Erythrocyte sedimentation rates（ESR） raised in 169 cases.All patients were divided into 4 groups according to site and extent of the lesion.Group A included 74 cases who underwent anterior radical debridement and instrumentation.Group B included 70 cases who underwent posterior instrumentation and interlaminar bone graft plus anterior radical debridement and strut graft either by one-stage or two-stage.Group C included 10 cases who underwent front side radical debridment，strut graft and posterior instrumentation in thoracic or thoracolumbar spine.Group D included 27 cases who underwent single-stage posterior debridement and instrumentation.Emergency surgery was performed in 25 patients with neurological impairment following short term chemotherapy prior 6-18h before surgery.The chemotherapy medicine was administered to the remaining 156 cases over 3 weeks before surgery and continued till 12 months after operation.Result：The average operation time and blood loss were 3.5h and 450ml in group A，4.5h and 640ml in group B，3.0h and 350ml in group C and group D.Severe complications were not noted in each group.ESR returned to normal 8-12 weeks after operation.Kyphosis was corrected by（47.5±11.8）% in group A，（61.5±18.6）% in group B，（58.7±15.9）% in group C and （59.9±17.4）% in group D，with loss of correction at final follow-up of （64.8±19.3）% in group A，（53.6±15.6）% in group B，（56.9±11.8）% in group C and （54.9±15.4）% in group D.And at final follow-up，18 cases had Frankel level improved 1 level，and 7 cases had it improved 2 levels.Sinus was found in the each of Group A，B and C at half a month，one month and one and a half months respectively，which was healed by proper intervention 1-2 months later.Instrument loosening was found in 1 patient of group A one year later，however no intervention was performed due to evidenced fusion.No recurrence was observed at final follow-up in all groups.Conclusion：Different surgical approaches are indicated for debridement, decompression and kyphosis correction，which are reliable for spinal tuberculosis.Posterior approach is superior than anterior approach due to its deformity correction and maintaining of correction. |
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