Posterior approach alone versus combined anterior and posterior approach in the management of vertebral tuberculosis

Abstract

AIM: To compare posterior surgery alone versus combined anterior and posterior surgery for the management of spinal tuberculosis. MATERIAL and METHODS: Data from 31 consecutive patients who underwent surgery for spinal tuberculosis were analyzed retrospectively. Patients were divided into two groups as group A (posterior surgery alone) or group B (combined anterior and posterior surgery), and groups were compared in terms of invasiveness of the procedure, spinal deformity, fusion, neurological status, and postoperative complications. RESULTS: Group A included 16 patients (mean age: 56 years, range: 29-75) with a mean follow-up period of 29 months (range 12-60) while group B included 15 patients (mean age: 60 years, range: 35-73) with a mean follow-up period of 28 months (range 12-60). Procedurally, average operation time and mean length of hospitalization were shorter, and mean blood loss was lower in group A (p<0.05) compared to group B. Postoperative bone fusion took significantly (p<0.05) longer time in group A (10.5 ± 2.1 months)than in group B (9.3 ± 3.1 months), and all patients with a neurological deficit recovered completely during the postoperative period. No significant differences were observed between two groups with respect to postoperative complications (p>0.05). CONCLUSION: Combined anterior-posterior surgery may not be required for treating vertebral tuberculosis as posterior surgery alone appears to be sufficient.

Clinical outcomes and surgical strategy for spine tuberculosis: a systematic review and meta-analysis

“…Recovery of neurological function was largely measured using the ASIA grade or Frankel in the included studies. The findings were reported in 12 investigations [ 9 , 10 , 15 , 18 , 19 , 21 – 26 , 28 ]. In general, subjects improved their ASIA scores by one grade.…”

“…Chemotherapy lasted at least 2 weeks before the operation Posterior approach was combined with debridement, interbody autografting, and instrumentation Anterior approach was combined with debridement, interbody autografting, and instrumentation Huirong, 2017 [ 11 ] Anterior approach Posterior approach Yuliang, 2017 [ 12 ] Patients received the HREZ chemotherapy regimen of isoniazid (300 mg/d), rifampicin (450 mg/d), ethambutol (750 mg/d), and pyrazinamide (1500 mg/d) preoperatively for at least 2 weeks Anterior VATS Posterior only Li, 2019 [ 13 ] All patients received quadruple standard antituberculous chemotherapy, including oral administration of isoniazid (300 mg per day), rifampin (450 mg per day), pyrazinamide (750 mg per day), and ethambutol (750 mg per day). Anti-TB chemotherapy lasted for at least 2 weeks before any surgeries Anterior transthoracic debridement and fusion Posterior transpedicular debridement and fusion Sun, 2019 [ 14 ] Anterior only approach with the ARCH plate system Anterior + posterior Demirel, 2019 [ 15 ] Posterior alone Posterior + anterior Zhao, 2020 [ 16 ] The patients received anti-TB treatment for at least 2 weeks before surgery. The anti-TB treatment doses consisted of 0.3 g oral quaque die (QD) of isoniazid, 0.45 g oral QD of rifampicin, 0.75 g oral QD of ethambutol, and 0.5 g ter in die (TID) of pyrazinamide, and levofloxacin 0.2 g intravenously (IV) bis in die (BID) was given during hospitalization Anterior approach Posterior approach Musali, 2020 [ 17 ] Anterolateral decompression and spinal stabilization Posterolateral decompression by costotransversectomy and spinal stabilization Qiu, 2022 [ 18 ] All patients without indications of emergency surgery were routinely treated with preoperative anti-tuberculosis chemotherapy for 2–3 weeks, as well as the day of operation.…”

“…In 12 of the included studies, hospitalization was reported [ 10 – 12 , 14 , 15 , 17 – 19 , 23 , 25 , 27 , 28 ]. When comparing the anterior and posterior techniques, 5 out of 9 studies found that surgery performed with the anterior route resulted in a shorter hospital stay [ 10 – 12 , 14 , 15 , 23 , 25 , 27 , 28 ]. There was no discernible difference between the combined and posterior approaches.…”

One-stage freehand minimally invasive pedicle screw fixation combined with mini-access surgery through OLIF approach for the treatment of lumbar tuberculosis

“…Posterior surgery shows advantages in deformity correction and stability reconstruction, but with a controversy of thorough lesion debridement and ideal anterior column bone graft [ 17 , 18 ]. Anterior combined posterior surgery could achieve radical debridement and strong internal fixation, but with more surgical trauma and longer postoperative recovery [ 19 ]. There is still debate in surgical approach for lumbar TB until now.…”

One-stage freehand minimally invasive pedicle screw fixation combined with mini-access surgery through OLIF approach for the treatment of lumbar tuberculosis

“…Posterior surgery shows advantages in deformity correction and stability reconstruction, but with a controversy of thorough lesion debridement and ideal anterior column bone graft [15,16]. Anterior combined posterior surgery could achieve radical debridement and strong internal xation, but with more surgical trauma and longer postoperative recovery [17]. There is still debate in surgical approach for lumbar TB until now.…”