Comparative study of debridement, fusion and instrumentation via single stage anterior or single stage posterior approach in dorsolumbar spinal tuberculosis

Abstract

Background: There is controversy regarding approach for surgical treatment of dorsolumbar spinal tuberculosis. The aim of this study is to make a comparative study on the basis of clinico-serological, radiological, neurological, pain improvement and kyphotic angle correction between anterior and posterior surgery in dorsolumbar spinal tuberculosis. Materials and methods: The study was performed on a cohort comprising of 40 patients treated surgically between Feb'09 to Jan'13. All these patients were analyzed and divided into two groups on the basis of surgical approach. Group I comprised 18 patients who underwent anterior debridement, decompression and instrumentation by either transthoracic transpleural or thoracoabdominal diaphragm cutting or retroperitoneal approach depending upon location of lesions. Group II comprised 22 patients who were operated by posterior transpedicular decompression, debridement and instrumentation with or without anterior interbody cage through midline posterior approach. Various parameters were assessed like surgical time, intra-operative blood loss, improvement in ESR, neurological recovery, correction of kyphosis and loss of correction of kyphosis, VAS pain score, functional outcome by Prolo's scale and fusion according to Bridwell criteria. Results: Mean surgical time was more in Group I than Group II. Average blood loss was less in Group I. Clinico-serological outcome was better in Group I when compared to Group II. Regarding neurological outcome all patients improved at least 1 grade except one patient in Group II who deteriorated from Frankel D to Frankel C. Mean kyphotic angle correction was better in Group II with less loss of correction (LOC). Post-operative pain improvement, functional outcome and fusion based on Bridwell criteria were better in Group II compared to Group I. Conclusion: Single stage posterior approach with transpedicular decompression, debridement, fusion and instrumentation is better than anterior approach owing to its better functional outcome, less morbidity, early mobilization and rehabilitation, better kyphotic correction and better maintenance of correction.