Wenjie Wu1, Jingtong Lyu1, Xun Liu1, Fei Luo1, TianYong Hou1, Qiang Zhou1, Zhilin Li2, Yuan Chen3, Li Tao Li4, Yonghong Zheng5, Gaoju Wang6, Jianzhong Xu7, Zehua Zhang8. 1. Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China. 2. Department of Orthopaedics, The Lanzhou general Hospital, Lanzhou Military Command of CPLA, Lanzhou, China. 3. Department of Orthopaedics, Yulin People's Hospital, Yulin, China. 4. Department of Orthopaedics, The People's Liberation Army No. 309 Hospital, Beijing, China. 5. Department of Orthopaedics, Xi'an Jiaotong University Affiliated Honghui Hospital, Xi'an, China. 6. Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China. 7. Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China. Electronic address: xujzspine@126.com. 8. Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China. Electronic address: hangzehuatmmu@163.com.
Abstract
OBJECTIVE: The aim of the present multicenter, retrospective study was to assess the safety and effectiveness of different surgery strategies for the treatment of thoracic tuberculosis and to provide a reference for surgical treatment of thoracic tuberculosis. MATERIALS AND METHODS: This study reviewed 394 patients with thoracic tuberculosis who were treated in 6 institutions between January 2000 and January 2015. There were 208 men and 186 women with an average age of 34.92 ± 13.14 years (range 5-76 years). A total of 73 patients underwent one-stage anterior surgery (group A); 84 underwent an anterior combined posterior surgery (group B); and 237 underwent one-stage posterior surgery (group C). Clinical outcome, laboratory indexes, and radiologic results were analyzed to observe the advantage of posterior approach surgery. RESULTS: All cases were followed up for about 26-60 months (average of 37 months). At the last follow-up, all patients reached bone fusion, pain relief, and neurologic recovery. There were significant differences before and after treatment in terms of the visual analog scale and Oswestry Disability Index scores (P < 0.05). Posterior approach significantly improved kyphosis (P < 0.05). CONCLUSIONS: Posterior fixation is superior to anterior fixation in the correction of kyphosis and maintenance of spinal stability. One-stage posterior surgery can achieve the same efficacy as anterior-only or combined surgery, with less trauma, less blood loss, and shorter operative times. However, for wide lesions or paraspinal abscesses, severe bone destruction, and anterior and middle column defects that are too large after debridement to require long segment bone grafting, the anterior combined posterior approach is indispensable.
OBJECTIVE: The aim of the present multicenter, retrospective study was to assess the safety and effectiveness of different surgery strategies for the treatment of thoracic tuberculosis and to provide a reference for surgical treatment of thoracic tuberculosis. MATERIALS AND METHODS: This study reviewed 394 patients with thoracic tuberculosis who were treated in 6 institutions between January 2000 and January 2015. There were 208 men and 186 women with an average age of 34.92 ± 13.14 years (range 5-76 years). A total of 73 patients underwent one-stage anterior surgery (group A); 84 underwent an anterior combined posterior surgery (group B); and 237 underwent one-stage posterior surgery (group C). Clinical outcome, laboratory indexes, and radiologic results were analyzed to observe the advantage of posterior approach surgery. RESULTS: All cases were followed up for about 26-60 months (average of 37 months). At the last follow-up, all patients reached bone fusion, pain relief, and neurologic recovery. There were significant differences before and after treatment in terms of the visual analog scale and Oswestry Disability Index scores (P < 0.05). Posterior approach significantly improved kyphosis (P < 0.05). CONCLUSIONS: Posterior fixation is superior to anterior fixation in the correction of kyphosis and maintenance of spinal stability. One-stage posterior surgery can achieve the same efficacy as anterior-only or combined surgery, with less trauma, less blood loss, and shorter operative times. However, for wide lesions or paraspinal abscesses, severe bone destruction, and anterior and middle column defects that are too large after debridement to require long segment bone grafting, the anterior combined posterior approach is indispensable.