A posterior versus anterior debridement in combination with bone graft and internal fixation for lumbar and thoracic tuberculosis

BACKGROUND Surgery treatment is usually required for spinal tuberculosis. The aim of this study was to compare the clinical efficacy and outcomes of anterior and posterior surgical approach in combination with debridement, bone grafting, and internal fixation. METHODS All patients with thoracic and lumbar tuberculosis who underwent either the anterior or posterior surgery in combination with debridement, bone grafting, and internal fixation from August 2009 to August 2016 were reviewed retrospectively. RESULTS A total of 186 patients were recruited in the analyses, 37 of whom received the anterior approach and 149 treated with the posterior approach. In the entire study population, there was no statistically significant difference between the groups in terms of kyphosis Cobb's angle, VAS pain score, neurological status, operation duration, perioperative blood loss, and hospitalization days (p > 0.05). Good clinical outcomes were achieved in both treatment groups. In lumbar vertebra-affected patients, the average preoperative kyphosis Cobb's angle was 8.7 ± 16.6° and - 5.6 ± 16.0° for the anterior and posterior groups, respectively, which were corrected to - 3.3 ± 13.2° and - 10.1 ± 13.8° after surgery. For thoracic vertebra-affected patients, the corrected kyphosis Cobb's angle was 8.1 ± 9.7° and 10.3 ± 6.5°, respectively. After surgery, 32.4% of patients in the anterior group and 48.3% of patients in the posterior group claimed no pain (p = 0.24), while 83.8 and 85.9% recovered to Frankel grade E, respectively (p = 0.85). CONCLUSIONS The posterior debridement joint bone graft and internal fixation is an alternative procedure to treat lumbar and thoracic tuberculosis compared to the traditional anterior approach with similar clinical efficacy in terms of pain control, Cobb's angle, and neurological function. The posterior approach is sufficient for lesion debridement.