Comparison between the antero-posterior and anterior approaches for treating L5-S1 vertebral tuberculosis

Abstract

Purpose Both the antero-posterior and anterior approaches have been used for treating L5-S1 vertebral tuberculosis. However, no studies have compared the efficacy of the two methods in treating the disease. Methods The antero-posterior (AP group, 14 cases) and anterior (A group, 13 cases) approaches were performed on L5-S1 vertebral tuberculosis cases who were followed up for average of 25 months. Clinical and radiographic data were obtained from and compared between groups. Results Average operative time, blood loss and pre-operative, post-operative and last follow-up of lumbo-sacral angles for groups AP and A were 497 min vs 190 min, 980 ml vs 410 ml, 22.3°vs 20.6°, 29.8°vs 25.7°and 28.3°vs 23.6°, respectively. Averaged visual analogue scale (VAS) scores in groups AP and A, respectively, were 6.5 vs 6.0 points before surgery and 3.0 vs 2.8 points after surgery. Mean ODI scores were 60.2 vs 63.0 points before and 30.0 vs 28.5 points after the operation for groups AP and A, respectively. Six cases in the AP group and five in the A group who exhibited neurological symptoms recovered to American Spinal Injury Association (ASIA) grade E. The average hospitalisations of groups AP and A lasted for 21 and 15 days, respectively. Bony fusion was achieved in both groups, with an average fusion time of five and four months, respectively. Conclusions Both the antero-posterior and anterior approaches can effectively heal L5-S1 vertebral tuberculosis, but the average surgical time, blood loss and hospital stay following the anterior approach are prominently less than those following the antero-posterior approach.

Instrumented circumferential fusion for tuberculosis of the dorso-lumbar spine. A single or double stage procedure?

“…Also, the mean estimated blood loss was smaller. Similar findings were reported by other workers [30]. In this study the incidence of complications was significantly lower in the one-stage group when compared with the two-stage group.…”

One‐Stage Anterior Approach with Arch Plate to Treat Lumbosacral Tuberculosis

“…However, all existing anterior lumbosacral internal fixation systems, such as SynFix‐LR (Synthes, Solothurn, Switzerland), the Trinica anterior lumbar plate system (Zimmor, Minneapolis, MN, USA), and the Pyramid anterior lumbar plate (Sofamor, Menphis, TN, USA), cannot be applied to spinal tuberculosis patients who have irregular bony endplate destruction. He and Xu performed a single‐stage anterior debridement and autograft fusion combined with two self‐locking titanium anterior lumbosacral vertebrae plates (SCIENT X, Parc Ariane, FRANCE) in order to treat 13 cases of lumbosacral tuberculosis. The average operative time, blood loss, hospital stay, and lumbosacral correction angle were 190 min, 410 mL, 15 days, and 5.1°, respectively, which proved the safety and efficacy of the one‐stage anterior surgical procedure.…”

Comparison of One versus Two Cages in Lumbar Interbody Fusion for Degenerative Lumbar Spinal Disease: a Meta‐analysis

“…The main deficiencies of this study were that it included only two RCTs, and the sample sizes in these two trials were small: 25 and 91 patients, respectively. However, the follow‐up time was mainly about two years, which is enough time to accurately assess bone fusion. In Suh et al .…”

“…The main deficiencies of this study were that it included only two RCTs 15,16 , and the sample sizes in these two trials were small: 25 and 91 patients, respectively. However, the follow-up time was mainly about two years, which is enough time to accurately assess bone fusion [31][32][33] . In Suh et al's trial 16 , nine patients lost to follow-up were excluded, rather than carrying out an intention-to-treat analysis.…”