Comparison of clinical efficacy and complications between anterior and posterior operations in the treatment of upper thoracic tuberculosis

English Keywords:Upper thoracic tuberculosis  Debridement  Anterior approach  Posterior approach

English Abstract:

  【Abstract】 Objectives: To compare the clinical efficacy and complication rate between anterior and posterior approaches in the treatment of upper thoracic tuberculosis(T1-T5). Methods: Retrospective analysis on 29 patients with upper thoracic tuberculosis, who underwent operation in our department from April 2005 to April 2014. Among them, 13 patients(7 males and 6 females, aged 22-70, mean age 46.3±15.0) were treated with one-stage anterior radical debridement and interbody fusion with instrumentation(anterior group); 16 patients(7 males and 9 females, aged 26-72, mean age 52.6±13.0) were treated with one-stage posterior radical debridement and interbody fusion with instrumentation(posterior group). For all 29 patients, anti-tuberculosis drugs were given for 12 to 18 months after operation, and the follow-up periods were more than 2 years. Differences in operation time, blood loss, length of stay(LOS), perioperative complications of the two groups were compared, and neurological improvement, thoracic and back pain VAS score, bone graft fusion time, kyphosis correction and recurrence rate from follow-up data were analyzed. Results: Operations in both groups completed smoothly. The operation time, intraoperative blood loss and LOS of the anterior group and posterior group were 239.1±52.86min and 228.0±26.78min, 588.5±196.0ml and 537.5±208.6ml, 23.15±3.13d and 16.81±3.19d, respectively. The LOS of the anterior group was longer than that of the posterior group(P<0.05). There were 8 cases of complications in the anterior group (2 cases of pleural effusion, 1 of winged scapula, 1 of pneumothorax, 1 of atelectasis, 1 of intercostal neuralgia, 1 of iliac donor region pain, and 1 of pneumonia with refractory hyponatremia), whereas 4 cases of complications occurred in the posterior group(2 cases of cerebrospinal fluid leakage, 1 of delayed wound healing, 1 of transient neurological function worsening). The complication rate of the anterior group(8/13, 61.54%) was greater than that of the posterior group(4/16, 25%)(P<0.05). All 29 patients in both groups were clinically cured without tuberculosis recurrence during the follow-up of 40-87(62.1±13.0) months. The Cobb angle was 39.2°±9.4° before operation, 19.4°±4.7° after operation, and 22.5°±7.4° at the final follow-up, with correction loss of 3.1°±2.3° in the anterior group, and that was 40.6°±7.3°, 18.5°±3.5°, and 21.2°±4.4° respectively in the posterior group, with correction loss of 2.7°±1.6°. There was no significant difference between the two groups(P＞0.05). In terms of the bone graft fusion time, the anterior group(6.2±1.6 months) was shorter than the posterior group(8.4±1.5 months), and the difference was statistically significant(P＜0.05). The neurological improvement rates and thoracic and back pain VAS scores of the anterior group and posterior group at the final follow-up were 100% and 93.75%, 2.16±0.75 and 2.01±0.68, respectively, and the difference was not statistically significant(P＞0.05). Conclusions: Both anterior and posterior approaches can be performed in the surgical treatment of upper thoracic tuberculosis. Comparing with posterior approach, in anterior approach operation the bone graft fusion time was shorter, however, the incidence of perioperative complications was higher.