Surgical management of consecutive multisegment thoracic and lumbar tuberculosis: anterior-only approach vs. posterior-only approach

Chen Zhao,Fei Luo,Pei Li,Liehua Liu,Lichuan Liang,Yongjian Gao,Lei Luo,Qiang Zhou,Jianzhong Xu

doi:10.1186/s13018-020-01876-3

Abstract

PurposeTo compare the efficacy, safety, and technical characteristics of anterior-only and posterior-only approach surgeries for the treatment of consecutive multisegment thoracic and lumbar tuberculosis.MethodsThirty-five patients who developed consecutive multisegment thoracic and lumbar tuberculosis from September 2012 to May 2016 were retrospectively analyzed. Group A was the posterior-only surgery group, and group B was the anterior-only surgery group. The data on the surgery, deformity correction, functional scores, and complications were compared between the two groups.ResultsThere was no significant difference in the operation time or blood loss between groups A and B (P > 0.05). The preoperative average Cobb angle of kyphosis in groups A and B were 36.2 ± 15.2° and 27.9 ± 7.7°, respectively, which significantly decreased to 4.9 ± 11.8° and 10.4 ± 5.6° after the operation, respectively (P < 0.05). At the final follow-up, the angles were 7.1 ± 10.5° and 14.6 ± 8.0°. The correction angle and correction rate in group A (31.3 ± 16.6°, 88.6 ± 43.6%) were greater than those in group B (17.5 ± 4.4°, 64.9 ± 14.0%) (P < 0.05). There was no significant difference in the loss angle between groups A and B (P > 0.05), but the loss rate in group B (24.0 ± 27.8%) was higher than that in group A (9.6 ± 10.2%) (P < 0.05). There was no significant difference in the incidence of complications between the two groups (P > 0.05).ConclusionThe posterior-only and anterior-only approaches can lead to satisfactory clinical results in the treatment of patients with consecutive multisegment thoracic and lumbar tuberculosis. With posterior-only surgery, kyphosis can be better corrected, and the correction can be better maintained than with anterior-only surgery.

Highlights

After 20 years of tuberculosis (TB) prevention and treatment efforts, the incidence of TB has decreased significantly; the incidence is still high in economically underdeveloped areas in China [1]
Thoracic and lumbar TB mostly damages the anterior column of the spine, and the collapse of the anterior column leads to kyphosis [4]
The exclusion criteria were as follows: (1) inconsecutive multisegment thoracic and lumbar TB; (2) recurrence spinal TB; (3) TB combined with severe osteoporosis; and (4) TB combined with diseases that affect clinical observations, such as lumbar disc herniation

Summary

Introduction

After 20 years of tuberculosis (TB) prevention and treatment efforts, the incidence of TB has decreased significantly; the incidence is still high in economically underdeveloped areas in China [1]. China is the country with the second largest number of new TB cases worldwide [2]. Spinal TB is the most common extrapulmonary TB and most cases involve a single segment; more than one segment is rarely involved [3]. The incidence of TB is highest in the thoracic spine, followed by the lumbar spine. Thoracic and lumbar TB mostly damages the anterior column of the spine, and the collapse of the anterior column leads to kyphosis [4]. Multisegment vertebral destruction increases the risk of kyphosis and neurologic impairment [5, 6]. More multisegment cases than single-segment spinal TB cases require surgical treatment

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