Comparison of Long-Term Clinical and Radiographical Outcomes Between the Anterior and Combined Anterior and Posterior Approaches for Treating Lumbosacral Tuberculosis

Overview

Journal Orthop Surg

Specialty Orthopedics

Date 2023 Feb 7

PMID 36750359

Authors

Zhuang Zhang

Bo-Wen Hu

Lin-Nan Wang

Tao Li

Hui-Liang Yang

Li-Min Liu

Yue-Ming Song

Zhong-Jie Zhou

Affiliations

Soon will be listed here.

Abstract

Objective: Both anterior and combined anterior and posterior approaches have been used to treat lumbosacral tuberculosis. However, long-term follow-up studies of each approach have not been conducted. We aimed to compare the long-term clinical and radiographical outcomes between the two approaches.

Methods: In this retrospective cohort study, we included 49 patients with a minimum 6-year follow-up between January 2008 and March 2012. Twenty-four patients underwent the anterior approach (anterior group), and 25 underwent the combined anterior and posterior approach (anterior-posterior group). Student's t test, Mann-Whitney U test, and Pearson's chi-square test were used to compare the two groups regarding clinical data, such as visual analogue scale scores, Oswestry disability index scores and neurological status, and radiographical data, such as lumbosacral angle, lumbar lordosis, and L5-S1 height. Furthermore, operative time, length of stay, and intraoperative and postoperative blood loss (IBL, PBL) were recorded.

Results: Both groups had satisfactory clinical and radiographical outcomes until the final follow-up. All patients achieved bony fusion, and no group differences were found in any of the clinical indices. Both groups corrected and maintained the lumbosacral angle, lumbar lordosis, and L5-S1 height. However, the operative time, length of stay, maximum Hb drop, IBL, and PBL of the anterior group (140.63 ± 24.73 min, 12.58 ± 2.45 days, 28.33 ± 9.70 g/L, 257.08 ± 110.47 ml, and 430.60 ± 158.27 ml, respectively) were significantly lower than those of the anterior-posterior group (423.60 ± 82.81 min, P < 0.001; 21.32 ± 3.40 days, P < 0.001; 38.48 ± 8.03 g/L, P < 0.001; 571.60 ± 111.04 ml, P < 0.001; and 907.01 ± 231.99 ml, P < 0.001).

Conclusion: This retrospective study demonstrated long-term efficacy of the anterior approach with a single screw fixation, which was as effective as that of the combined anterior and posterior approach, with the advantage of less trauma.

References

Song J, Jing Z, Chen B, Ai Z, Hu W . One-stage anterolateral surgical treatment for lumbosacral segment tuberculosis. Int Orthop. 2011; 36(2):339-44. PMC: 3282850. DOI: 10.1007/s00264-011-1378-4. View

Smorgick Y, Baker K, Bachison C, Herkowitz H, Montgomery D, Fischgrund J . Hidden blood loss during posterior spine fusion surgery. Spine J. 2013; 13(8):877-81. DOI: 10.1016/j.spinee.2013.02.008. View

Liu Z, Zhang P, Li W, Xu Z, Wang X . Posterior-only vs. combined posterior-anterior approaches in treating lumbar and lumbosacral spinal tuberculosis: a retrospective study with minimum 7-year follow-up. J Orthop Surg Res. 2020; 15(1):99. PMC: 7063822. DOI: 10.1186/s13018-020-01616-7. View

Sun D, Zhang Z, Mei G, Hou T, Li Y, Xu J . Comparison of Anterior only and Combined Anterior and Posterior Approach in Treating Lumbosacral Tuberculosis. Sci Rep. 2019; 9(1):18475. PMC: 6898139. DOI: 10.1038/s41598-019-53800-3. View

Sundararaj G, Behera S, Ravi V, Venkatesh K, Cherian V, Lee V . Role of posterior stabilisation in the management of tuberculosis of the dorsal and lumbar spine. J Bone Joint Surg Br. 2003; 85(1):100-6. DOI: 10.1302/0301-620x.85b1.13300. View

Siepe C, Stosch-Wiechert K, Heider F, Amnajtrakul P, Krenauer A, Hitzl W . Anterior stand-alone fusion revisited: a prospective clinical, X-ray and CT investigation. Eur Spine J. 2014; 24(4):838-51. DOI: 10.1007/s00586-014-3642-y. View

Zhang T, He X, Li H, Xu S . Treatment of lumbosacral spinal tuberculosis by one-stage anterior debridement and fusion combined with dual screw-rod anterior instrumentation underneath the iliac vessel. BMC Musculoskelet Disord. 2016; 17:49. PMC: 4736612. DOI: 10.1186/s12891-016-0902-5. View

Xu Z, Wang X, Shen X, Luo C, Wu P, Zeng H . One-stage lumbopelvic fixation in the treatment of lumbosacral junction tuberculosis. Eur Spine J. 2015; 24(8):1800-5. DOI: 10.1007/s00586-015-3863-8. View

Brantigan J, Steffee A . A carbon fiber implant to aid interbody lumbar fusion. Two-year clinical results in the first 26 patients. Spine (Phila Pa 1976). 1993; 18(14):2106-7. DOI: 10.1097/00007632-199310001-00030. View

10.

He Q, Xu J . Comparison between the antero-posterior and anterior approaches for treating L5-S1 vertebral tuberculosis. Int Orthop. 2011; 36(2):345-51. PMC: 3282841. DOI: 10.1007/s00264-011-1307-6. View

11.

Shah S, Kulkarni A . S1 tuberculosis treated with segmental lumbopelvic fixation: a case report. Spine (Phila Pa 1976). 2012; 37(14):E866-9. DOI: 10.1097/BRS.0b013e3182540579. View

12.

Rajasekaran S, Shanmugasundaram T, Prabhakar R, Dheenadhayalan J, Shetty A, Shetty D . Tuberculous lesions of the lumbosacral region. A 15-year follow-up of patients treated by ambulant chemotherapy. Spine (Phila Pa 1976). 1998; 23(10):1163-7. DOI: 10.1097/00007632-199805150-00018. View

13.

Korovessis P . Hidden Blood Loss in Spine Surgery for A1-A3 thoracolumbar Fractures. Comparison Between Three Approaches. J Invest Surg. 2018; 32(8):761-762. DOI: 10.1080/08941939.2018.1462418. View

14.

Yu W, Lou C, Liu F, He D . Clinical efficacy of one stage posterior debridement joint graft fixation for lumbar vertebral fractures in spinal tuberculosis patients with compression. Eur Rev Med Pharmacol Sci. 2016; 20(15):3161-7. View

15.

Gross J . Estimating allowable blood loss: corrected for dilution. Anesthesiology. 1983; 58(3):277-80. DOI: 10.1097/00000542-198303000-00016. View

16.

Kim D, Yun Y, Moon S, Riew K . Posterior instrumentation using compressive laminar hooks and anterior interbody arthrodesis for the treatment of tuberculosis of the lower lumbar spine. Spine (Phila Pa 1976). 2004; 29(13):E275-9. DOI: 10.1097/01.brs.0000129027.68574.06. View

17.

Rexiti P, Abudurexiti T, Abuduwali N, Deng Q, Guo H . Debridement and Internal Fixation from a Single Posterior Approach for the Treatment of Lumbosacral Tuberculosis. World Neurosurg. 2018; 120:e392-e399. DOI: 10.1016/j.wneu.2018.08.081. View

18.

Mao Z, Yue B, Wang Y, Yan M, Dai K . A comparative, retrospective study of peri-articular and intra-articular injection of tranexamic acid for the management of postoperative blood loss after total knee arthroplasty. BMC Musculoskelet Disord. 2016; 17(1):438. PMC: 5069893. DOI: 10.1186/s12891-016-1293-3. View

19.

Li B, Wang G, Wang Y, Bai L . Effect of Two Limb Positions on Venous Hemodynamics and Hidden Blood Loss following Total Knee Arthroplasty. J Knee Surg. 2016; 30(1):70-74. DOI: 10.1055/s-0036-1579787. View

20.

Zeng H, Wang X, Pang X, Luo C, Zhang P, Peng W . Posterior only versus combined posterior and anterior approaches in surgical management of lumbosacral tuberculosis with paraspinal abscess in adults. Eur J Trauma Emerg Surg. 2016; 40(5):607-16. DOI: 10.1007/s00068-013-0367-2. View