Posterior only versus combined posterior and anterior approaches for lower lumbar tuberculous spondylitis with neurological deficits in the aged

Abstract

Study design: Retrospective case-control study. Objectives: To analyze the results of two surgical treatments for lower lumbar tuberculous spondylitis with neurological deficits in the aged. Methods: We studied 33 cases of lower lumbar spinal tuberculous spondylitis treated in our center from January 2006 to October 2010. The cases were divided into two groups: 16 cases (group A) underwent single-or two-stage anterior debridement, bone grafting and posterior instrumentation, and 17 cases (group B) underwent single-stage posterior debridement, decompression, interbody fusion and instrumentation. Clinical and radiographic results were analyzed and compared between the groups. Results: Patients were followed for a mean of 41.3 months (range 36-48 months). The average operative durations were 276.9 ± 23.8 and 193.8 ± 22.5 min in groups A and B, respectively. The average hospital stay was 18.2 ± 3.2 days for group A and 13.4 ± 1.6 days for group B. Average intraoperative blood loss for groups A and B was 1187.5 ± 163.0 and 804.7 ± 134.1 ml, respectively. Operative complications affected four patients in group A and one in group B. Solid fusion occurred at 12 months in the other 32 cases. Neurological status was significantly improved in all cases. Kyphosis was significantly corrected after surgical management, but loss of correction occurred in both groups. Conclusion: Single-stage posterior debridement, decompression, interbody fusion and instrumentation might be a better surgical treatment than combined posterior and anterior approaches for lower lumbar tuberculous spondylitis with neurological deficits in the aged, offering fewer complications and a better quality of life.

Long-segment versus short-segment fixation through a posterior approach for tuberculous spondylodiscitis of the mid-thoracic spine in adults: a study of mid- to long-term efficacy

“…The rationale for using the posterior approach is based on removal of the pathological tissues and the ossi ed bone from around the lesion that prevents the entry of anti-TB drugs, thus destroying the favorable living environment essential for the survival of Mycobacterium tuberculosis. The rest of the small amount of lesion and abscesses can be absorbed with postoperative standardized anti-TB chemotherapy [18]. In our series, the ESR and CRP level returned to normal within 3 months postoperation, and all patients had achieved solid bone fusion at the nal follow-up.…”

One-stage posterior debridement, titanium mesh cage bone grafting and single-segment fixation for treating mono-segmental lumbar and lumbosacral spinal tuberculosis in adult patients following minimum 5-year follow-up

“…Furthermore, the posterior approach is less invasive and avoids possible damage to the large vessels, nerves or vital anatomical structures. Therefore, many surgeons recommend posterior-only approach for lumbar and lumbosacral spinal TB, which achieves good curative effects [7][8][9]20]. The rationality of the posterior approach is to remove the sequestrum that prevents anti-TB drugs from entering the lesions.…”

Single-stage transverse process resection, debridement, interbody fusion, and internal fixation for the treatment of lumbar spinal tuberculosis via posterior-only approach

“…Controversies on the strategy of a posterior-only approach in treating lumbar spinal TB mainly concentrated in whether surgeons can throughly perform debridement and anterior decompression in such a limited visual eld, whether it would achieve the anterior bony fusion, and whether it would maintain the spinal stability [23,24]. A number of advantages to the posterior-only approach were highlighted: reduced bleeding, shorter operation and hospitalization durations, released the nerve compression, corrected kyphosis deformity, regained spinal stability, and improved the quality of life of these patients [25].…”