Lateral Extracavitary Approach Versus Posterior Extensive Circumferential Decompression in the Treatment of Complicated Thoracic and Lumbar Tuberculous Spondylitis

Abstract

Both procedures attained good results for maintained deformity correction, bony fusion, spinal cord decompression, and neurological improvement in complicated tuberculous spondylitis. However, PECD may be superior to LEC.

Comparison of anterior, posterior, and anterior combined with posterior surgical treatment of thoracic and lumbar spinal tuberculosis: a systematic review

“…Twenty-five studies comparing the anterior, posterior, or anterior combined with posterior approach in treating spinal tuberculosis in the thoracic and lumbar regions were identified. 11 – 35 Table 1 summarizes the characteristics of the included studies. Among the 25 studies, the anterior surgical approach mainly referred to anterior debridement, decompression, and bone grafting with different fixations in a one- or two-stage procedure; the posterior surgical approach mainly referred to posterior debridement, decompression, and bone grafting with different fixations in a one- or two-stage procedure; and the anterior combined with posterior surgical approach referred to anterior and posterior (or posterior and anterior) debridement, decompression, and bone grafting with different fixations in a one- or two-stage procedure.…”

“…Twenty studies 11 , 12 , 14 , 16 – 18 , 20 , 22 – 26 , 28 – 35 reported the preoperative kyphosis angle and correction of the kyphosis angle in patients with thoracic and lumbar spinal tuberculosis ( Table 3 ).…”

“…Of the 20 studies, 13 studies 11 , 12 , 14 , 20 , 21 , 23 – 26 , 28 , 29 , 32 , 33 compared the preoperative kyphosis angle for the anterior approach (29.0 ± 10.19 degrees) versus the posterior approach (29.9 ± 14.2 degrees), and no statistically significant difference was detected (t = −0.197). Among the 20 studies, 10 studies 16 – 18 , 20 , 22 , 26 , 30 , 33 – 35 compared the preoperative kyphosis angle for the anterior combined with posterior approach (29.8 ± 8.5 degrees) versus the posterior approach (26.0 ± 10.9 degrees), and no statistically significant difference was detected (t = 0.871).…”

“…Twenty studies 11 – 14 , 16 – 18 , 20 – 22 , 24 – 31 , 33 , 35 reported various surgical complications in the treatment of thoracic and lumbar spinal tuberculosis ( Table 4 ). Overall, the incidence of surgical complications was as follows: anterior approach, 103/1879 (5.48%); anterior combined with posterior approach, 126/1904 (6.62%); and posterior approach, 67/2262 (2.96%).…”

Functional Outcomes in Spinal Tuberculosis: A Review of the Literature

“…This is probably due to the neurological consequences leading to disruption of functional abilities, emphasizing the indication for surgery. Studies that examined surgery techniques recorded a considerable number of patients with compromised preoperative neurological status [2,[7][8][9][10][13][14][15]23,25]. On the other hand, fewer studies evaluated functional outcomes from conservative management among individuals with spinal tuberculosis; however, those who underwent conservative management were less likely to have neurological deficits to begin with [16,17].…”