Abstract
<h3>BACKGROUND CONTEXT</h3> Both the anterior and combined anterior and posterior approaches have been used to treat lumbosacral tuberculosis. However, long-term follow-up studies of each approach have not been conducted. <h3>PURPOSE</h3> We aimed to compare the long-term clinical and radiological outcomes between the two approaches. <h3>STUDY DESIGN/SETTING</h3> Retrospective comparative study. <h3>PATIENT SAMPLE</h3> Fifty-nine patients with lumbosacral tuberculosis who underwent surgical treatment. Twenty-four patients underwent the anterior approach (group A) and 25 underwent the combined anterior and posterior approach (group AP). <h3>OUTCOME MEASURES</h3> We collected clinical data, such as visual analog scale scores, Oswestry Disability Index scores and neurological status, and radiographical data, such as lumbosacral angle and physiological lordosis. Furthermore, operative time, length of stay, and intraoperative and postoperative blood loss (IBL, PBL) were recorded. <h3>Methods</h3> We included 59 patients with a minimum 6-year follow-up between January 2008 to March 2012. Twenty-four patients underwent the anterior approach (group A) and 25 underwent the combined anterior and posterior approach (group AP). We collected clinical data, such as visual analog scale scores, Oswestry Disability Index scores and neurological status, and radiographical data, such as lumbosacral angle and physiological lordosis. Furthermore, operative time, length of stay, and intraoperative and postoperative blood loss (IBL, PBL) were recorded. <h3>Results</h3> Both groups had satisfactory clinical and radiographical outcomes until follow-up. All patients achieved bony fusion, and no group differences were found in any of the clinical indices. Both groups corrected and maintained lumbosacral angle and physiological lordosis. However, operative time, length of stay, maximum Hb drop, IBL, and PBL of group A (140.63 ± 24.73 min, 12.58 ± 2.45 d, 28.33 ± 9.70 g/L, 257.08 ± 110.47 mL, and 430.60 ± 158.27 mL, respectively) was significantly lower than those of group AP (423.60 ± 82.81 min, p < 0.001; 21.32 ± 3.40 d, p < 0.001; 38.48 ± 8.03 g/L, p < 0.001; 571.60 ± 111.04 mL, p < 0.001; and 907.01 ± 231.99 mL, p < 0.001). <h3>Conclusions</h3> This retrospective study demonstrated long-term efficacy of the anterior approach, which was as effective as that of the combined anterior and posterior approach, with the advantage of less trauma. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.
Highlights
Both the anterior and combined anterior and posterior approaches have been used to treat lumbosacral tuberculosis
Specific and effective antituberculous chemotherapy is the mainstay of treatment; if nonsurgical treatments fail, surgical interventions are considered
The posterior approach offers no advantage on debridement [6, 8]
Summary
Both the anterior and combined anterior and posterior approaches have been used to treat lumbosacral tuberculosis. Long-term follow-up studies of each approach have not been conducted. We aimed to compare the long-term clinical and radiographical outcomes between the two approaches. Lumbosacral junction (L5–S1) tuberculosis (LSTB) occurs in 2–3% of patients with spinal tuberculosis [1]. The one-stage posterior approach for treatment of LSTB can provide adequate internal fixation and stability reconstruction [4, 6, 7]. Patients with LSTB usually experience significant abscesses, and the destruction is often concentrated on the anterior vertebral columns. To achieve adequate lesion debridement, many surgeons implement the combined anterior and posterior approach [9, 10], this approach requires more extensive surgery, which usually results in more substantial trauma
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