Abstract
BackgroundTo compare the clinical efficacy of single posterior debridement, bone grafting and instrumentation with that of single-stage anterior debridement, bone grafting and posterior instrumentation for treatment of adult patients with thoracic and thoracolumbar spinal tuberculosis (TB).MethodsWe performed a retrospective analysis of 64 adult patients with thoracic and thoracolumbar spinal TB who underwent surgery between January 2011 and December 2014. Of the 64 patients, 34 patients were treated using a single posterior-only approach (posterior debridement, bone grafting and instrumentation; Group A). Thirty patients were treated with a combined anterior and posterior approach (single-stage anterior debridement, bone grafting and posterior instrumentation; Group B). Clinical manifestations, laboratory and imaging results were subjected to statistical analysis.ResultsThe mean (±standard deviation) duration of follow-up was 16.8 ± 1.4 months (range, 10–34). Bony fusion was achieved in all the bone grafts with no loosening or breakage of internal fixation. In both of the groups, the visual analog scale (VAS) pain score, ESR and CRP at 6 weeks after operation and at the most recent follow-up were significantly lower than the preoperative level (p < 0.05). The operation time, intraoperative blood loss and length of hospital stay in group A were significantly less than those in group B (P < 0.05). As of most recent follow-up, no significant between-group difference was observed with respect to the American Spinal Injury Association classification status (p > 0.05). Furthermore, no significant between-group difference was observed with respect to preoperative kyphosis angle, and postoperative angle correction and angle correction rate (P > 0.05). One patient in group A relapsed 20 months after operation, and was successfully treated with debridement using the combined anterior and posterior approach.ConclusionSingle posterior debridement, bone grafting and instrumentation for treatment of thoracic and thoracolumbar spinal TB can achieve similar curative effect as that with single-stage anterior debridement, bone grafting and posterior instrumentation, and is associated with additional advantages of shorter operation time, less bleeding and shorter length of hospital stay.
Highlights
To compare the clinical efficacy of single posterior debridement, bone grafting and instrumentation with that of single-stage anterior debridement, bone grafting and posterior instrumentation for treatment of adult patients with thoracic and thoracolumbar spinal tuberculosis (TB)
We explored the clinical outcomes of single posterior debridement, bone grafting and instrumentation and single-stage anterior debridement, bone grafting and posterior instrumentation for treatment of adult patients with thoracic and thoracolumbar spinal TB
The diagnosis of active spinal TB was based on clinical symptoms, laboratory investigations [high erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)], and radiographic examination [x-ray, computed tomography (CT), and magnetic resonance imaging (MRI)]
Summary
To compare the clinical efficacy of single posterior debridement, bone grafting and instrumentation with that of single-stage anterior debridement, bone grafting and posterior instrumentation for treatment of adult patients with thoracic and thoracolumbar spinal tuberculosis (TB). Reasonable debridement, internal fixation and fusion can significantly relieve back pain, improve neurological function, and prevent or correct kyphosis in these patients [3]. The combined use of anterior and posterior approach in a single-stage surgery serves to overcome the limitations of the anterior-only approach and has been widely adopted with good results [6, 7]. It should be noted that the use of a combined anterior and posterior approach increases the operation time, and is associated with greater trauma and higher risk of complications, not conducive to early rehabilitation of patients [3]. Good results have been reported with use of posterior approach [8, 9]; it is associated with inadequate treatment of the lesion in front of the vertebral body
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