Compare study on the effect of posterior only approach and anterior only approach surgery for lumbar tuberculosis in adults

English Keywords:Anterior spinal fusion  Spinal  Tuberculosis  Lumbar vertebrae

English Abstract:

  【Abstract】 Objectives: To compare and analyze the efficacy and advantages of anterior approach and posterior approach in the treatment of lumbar tuberculosis. Methods: Total 216 patients with lumbar tuberculosis from January 2002 to January 2012 were retrospectively analyzed, and 117 Patients with a single anterior or posterior surgical treatment and the follow-up no less than 3 years were enrolled. Among them, 45 patients underwent anterior approach only surgery(anterior approach group), and 72 patients underwent posterior approach only surgery(posterior approach group). The trauma indexes(operation time, bleeding volume, hospitalization time and complications), imaging indexes(bone fusion time, segment kyphosis and correction rate) and clinical efficacy evaluation indexes(Oswestry disability index, pain visual analogue scale and improvement rate) between the two groups were compared and analyzed statistically. Results: The operation time of the anterior approach group was 207.9±30.9min, the intraoperative blood loss was 409.5±107.9ml and the length of stay was 11.5±1.2 days, all of them were lower than those of the posterior approach group(287.5±30.7min, 835.7±161.9ml, 19.20±1.42d), the difference was statistically significant(P<0.05). The complication rate of the anterior approach group was 15.56%(7/45) and the posterior approach group was 13.89%(10/72). There was no significant difference between the two groups(P>0.05). The bone fusion time of the anterior approach group was 7.6±1.2 months and the posterior approach group was 7.5±1.2 months. There was no significant difference between the two groups(P>0.05). At the final follow-up, the kyphosis Cobb angle of the anterior approach group was 12.37°±1.58°, the improvement rate was (55.28±5.45)% compared to the preoperative angle(27.66°±6.83°). The mean postoperative kyphosis Cobb angle of the posterior approach group was 7.91°±1.34°, which was significantly higher than that of the preoperative one(28.84°±8.32°), and the improvement rate was (72.57±3.17)%. The posterior group was better than the anterior group in the improvement of the kyphosis(P<0.05). The ODI in the anterior approach group and posterior approach group was (10.10±1.38)% and (7.90±1.84)% at the final follow-up, and the improvement rate was (72.11±2.12)% and (78.55±1.57)% respectively. There was no significant difference between the two groups(P>0.05). The VAS scores were 1.21±0.67 and 2.31±0.83, and the improvement rates were (85.98±5.45)% and (72.57±5.04)% respectively, there were significant differences between the two groups(P<0.05). Conclusions: Both two approaches of surgical treatment of lumbar tuberculosis can get a good clinical efficacy, but the anterior approach has a shorter operation time, less blood loss, shorter hospital stay, lower incidence of postoperative low back pain owning to the protection of the normal posterior ligament complex(PLC).