Comparative study of a single posterior approach and combined posterior-anterior approach for patients with lower lumbar tuberculosis

Abstract

Background To compare the surgical effect of a single posterior approach with a combined posterior-anterior approach for patients with lower lumbar tuberculosis (TB). Method: 119 cases of lower lumbar TB were conducted from January 2008 to December 2016 using two procedures. Out of 119 cases, 73 patients were operated with a single posterior approach (group A), whereas, 46 patients were operated using the combined posterior-anterior approach (group B). The evaluative items were compared between two groups, including operation time, blood loss, surgical complication rate, cure rate, Visual Analog Scale (VAS) score, Japanese Orthopaedic Association (JOA) score, kyphosis Cobb’s angle, and time of abscess disappearance. Furthermore, the period between bone graft fusion and the patients’ return to regular activity were compared between the two groups to evaluate the therapeutic effects. Results No significant differences of gender, age, BMI, illness duration, and preoperative indexes of VAS, JOA, ESR, CRP, and kyphosis Cobb’s angle were found between the two groups of patients, who were followed-up for 24–60 months. Although the operation time and blood loss rate were less in group A as compared to group B, no remarkable differences in VAS, JOA, ESR, CRP and kyphosis Cobb’s angle were found. Furthermore, the rate of surgical complications, cure rate, and time of bone graft fusion did not show appreciable differences between the two groups. However, the time of abscess disappearance and time return to regular activity were less in group B as opposed to patients of group A. Conclusion Both single posterior approach and combined posterior-anterior approach are effective for the treatment of lower lumbar TB with a high cure rate and low surgical complication rate. Addtionally, single posterior approach is less traumatic than the combined posterior-anterior approach, but with a much slower lesion healing and activity recovery.