Peng Liu1, Mingwei Sun2, Shijun Li2, Zhihui Wang2, Guoqiang Ding2. 1. Department of Orthopedic Surgery, East Branch, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Science, 585 North Da Mian Hong He Ave, Long Quan District, Chengdu 610110, People's Republic of China. Electronic address: 160223209@qq.com. 2. Department of Orthopedic Surgery, East Branch, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Science, 585 North Da Mian Hong He Ave, Long Quan District, Chengdu 610110, People's Republic of China.
Abstract
OBJECTIVE: The purpose of this study was to determine the optimal operative approach for the treatment of spinal tuberculosis. We analyzed two types of pathological vertebrae (thoracic and lumbar) and three cardinal operative approaches for surgery. METHODS: Sixty patients with spinal tuberculosis were divided into thoracic (n=30) and lumbar groups (n=30) based on locations of the foci. These patients underwent anti-tuberculosis drug and surgical therapy. The operative approaches for the surgical treatments were the anterior approach (AA, n=20), posterior approach (PA, n=20), and combined anterior and posterior approach (CAPA, n=20). All clinical data from the patients was collected and included surgical time, blood loss, correction of kyphosis, and vertebral body height reconstruction. Differences in the means between the groups were evaluated statistically with one-way analyses of variance (ANOVAs). RESULTS: The surgery time in the CAPA group was longer than that of AA group (P<0.05), and there were no significant differences between the CAPA and PA groups or the AA and PA groups. The average vertebral body height reconstruction in the AA group was larger than that of the PA or CAPA groups, and there was no significant difference between the PA and CAPA groups (P>0.05). There were no interactions between the location of the pathological vertebra and the type of surgical approach, with the exception of blood loss. The blood loss of the CAPA was greater than those of the AA and PA patients in the thoracic group (P<0.05), and no significant difference was found in the lumbar group (P>0.05). CONCLUSIONS: AA was well-suited for serious vertebral collapse that required reconstruction of the height of the vertebrae. CAPA was unfit for patients with poor basic conditions due to the long surgical time, but the long surgery time of CAPA did not necessarily lead to greater blood loss compared to the other approaches.
OBJECTIVE: The purpose of this study was to determine the optimal operative approach for the treatment of spinal tuberculosis. We analyzed two types of pathological vertebrae (thoracic and lumbar) and three cardinal operative approaches for surgery. METHODS: Sixty patients with spinal tuberculosis were divided into thoracic (n=30) and lumbar groups (n=30) based on locations of the foci. These patients underwent anti-tuberculosis drug and surgical therapy. The operative approaches for the surgical treatments were the anterior approach (AA, n=20), posterior approach (PA, n=20), and combined anterior and posterior approach (CAPA, n=20). All clinical data from the patients was collected and included surgical time, blood loss, correction of kyphosis, and vertebral body height reconstruction. Differences in the means between the groups were evaluated statistically with one-way analyses of variance (ANOVAs). RESULTS: The surgery time in the CAPA group was longer than that of AA group (P<0.05), and there were no significant differences between the CAPA and PA groups or the AA and PA groups. The average vertebral body height reconstruction in the AA group was larger than that of the PA or CAPA groups, and there was no significant difference between the PA and CAPA groups (P>0.05). There were no interactions between the location of the pathological vertebra and the type of surgical approach, with the exception of blood loss. The blood loss of the CAPA was greater than those of the AA and PA patients in the thoracic group (P<0.05), and no significant difference was found in the lumbar group (P>0.05). CONCLUSIONS: AA was well-suited for serious vertebral collapse that required reconstruction of the height of the vertebrae. CAPA was unfit for patients with poor basic conditions due to the long surgical time, but the long surgery time of CAPA did not necessarily lead to greater blood loss compared to the other approaches.