Surgical management of tuberculosis of dorsal spine and dorsolumbar spine: Anterior versus posterior approach

Abstract

Background: Approach for surgical treatment of thoracolumbar tuberculosis (TB) has been controversial. The aim of the study is to compare the clinical, radiological and functional outcome of anterior versus posterior debridement and spinal fixation for the thoracic and thoracolumbar TBs. Materials and Methods: Thirty-four patients with dorsal spinal TB treated surgically between September 2011 and December 2013 were included in this study. Sixteen patients (Group 1) with a mean age of 34.5 years underwent anterior debridement, decompression, and instrumentation by anterior transthoracic, transpleural, and /or retroperitoneal diaphragm cutting approaches. Eighteen patients (Group 2) with a mean age of 35.4 years underwent posterolateral (extracavitary) decompression/posterior decompression and posterior instrumentation. Various parameters such as neurological recovery, improvement of symptoms, and prevention of kyphosis progression were compared. Neurological outcome is assessed by Nurick grade and Frankel grade. The mean follow-up is 12 months. Results: In the present study, 87.5% of the patients had neurological improvement in Group 1 and 61% had improvement in Group 2. In Group 1, 93% of the patients had reduction of back pain and in Group 2, 83% of the patients had reduction of back pain. In follow-up, both groups had equal fusion rates, and no implant displacement on x-rays. Except for one patient in Group 2, no patient had a worsening of deformity. Conclusion: Anterior approach is better for debridement and decompression of the spinal cord and stabilization than posterior approach.