Surgical outcome of anterior versus posterior surgical approach for thoracic and lumbar Pott′s disease

Abstract

ObjectivesThis retrospective study aimed to determine the surgical outcome of anterior versus posterior approach by comparing the operative duration, blood loss, intraoperative complications, postoperative complications, neurological status, bony fusion, and kyphotic angle for Pott's disease of the spine.Patients and methodsWe retrospectively reviewed 42 patients with Pott's disease of the thoracic and lumbar region who underwent surgery following the anterior approach (group A, 23 patients) or the posterior approach (group B, 19 patients) in Cairo University Hospitals between August 2007 and October 2010. The indication for surgery in all patients was instability or neurological deficits. All patients underwent surgical intervention by either approach and had decompression, debridement, fixation, and placement of an interbody bone autograft.ResultsThe anterior approach was used in 23 patients, whereas the posterior approach was used in 19 patients. All patients were followed up with plain radiographs and computed tomography scans immediately after surgery and at 3, 6, and 12 months postoperatively. Two complicated cases were followed up for 2 months inside the hospital. All patients operated upon established immediate stability, except one who developed complete stability a year later. None of the cases developed new neurological deficits after surgery. Excellent clinical outcomes were achieved in both groups. Only one case of mortality took place 7 months after surgery because of pulmonary embolism following deep venous thrombosis. Superficial wound infection occurred in three cases.ConclusionWe conclude that operative intervention through either the anterior or the posterior approach allows adequate debridement of tuberculous granulation tissue and cold abscess. Debridement with fixation of the diseased segment of the spine offers better chances for success of postoperative medical therapy. Both anterior and posterior approaches allow early decompression, control of pain, and adequate control of kyphosis.