Anterior versus posterior surgery for mono-segmental thoracic spinal tuberculosis: selection of the optimal approach and comparison of outcomes

Objective: To compare the clinical outcomes of anterior video-assisted thoracoscopic surgery (VATS) and the posterior-only approach for surgically treating mono-segmental thoracic spinal tuberculosis (TB) in adults. Methods: Between December 2008 and December 2010, we enrolled 52 males and 38 females. Fifty-two patients (mean age, 42.3±11.5 years; range, 22-66 years) in group A underwent anterior debridement, bone grafting, and instrumentation via the VATS approach. Thirty-eight patients (mean age, 43.8±12.0 years; range, 25-68 years) in group B underwent the posterior-only approach. Clinical and radiographic results were analyzed and compared between the two groups, with a minimum 5-year follow-up. Results: Spinal TB was completely cured and the grafted bones were fused within 9 months in all patients. A significant difference between groups was demonstrated in terms of TB lesion location. In group A, the lesion was most commonly located in the mid-thoracic vertebrae, while in group B, it was seen in the upper thoracic vertebrae. The average visual analogue scores for back pain and Japanese Orthopaedic Association and Short Form Health Survey indices were significantly improved between the two groups. The average operative time, blood loss, and hospitalization were significantly greater in group A than in group B. Kyphotic deformity was significantly corrected after surgery; however, the correction rate was higher in group B than in group A. In multivariate analysis, the two influence factors, focus location and kyphosis angle were independently associated with the selection of anterior or posterior surgery preoperatively. Conclusion: The anterior VATS approach can lead to more complete rehabilitation and reduced traumatization; however, the posterior-only approach is preferred for TB lesions located in the proximal thoracic spine, especially when combined with prominent kyphotic deformity.