gms | German Medical Science

Objectives: Tuberculosis of the dorsal spine is a very serious situation which may cause paraplegia and disability. The choice of surgical approach, whether anterior, posterior or combined has been controversial. This study compares the clinical, radiological and functional outcome of anterior versus posterior debridement fusion for dorsal tuberculosis

Methods: Thirty-one patients, 15 males and 16 females in 2 groups. Anterior group (AG): 14 cases with mean age of 51.4±10.3 treated with debridement, decompression, rib or iliac grafting and Z-plate fixation by anterior transthoracic transpleural approach. Posterior group (PG): 17 cases with mean age of 48.1±6.8 treated with debridement, decompression, local or iliac grafting and transpedicular fixation (2 levels above and 2 below lesion) through a lateral rachotomy. Assessment was done using Frankle classification, blood-loss, operative-time, Cobb-angle, loss of correction, union and Oswestry disability index (ODI)

Results and Conclusion: Both groups were similar in age, gender and occupation. Both have similar operative time (170.0±16.6 versus 155.0±25.7 minutes in AG and PG respectively), similar blood-loss (821.4 versus 935.2 ml.); similar time to union was 13.6±1.7 (AG) versus 14.1±2.2 weeks (PG) and similar hospital-stay (6.7±2.3 versus 7.2±2.1 days in AG and PG respectively). Cobb angle improved from 58.1±10.2° to 23.5±4.1° (AG); and from 45.3±7.8° to 27.3±3.5° (PG) and this was statistically significant (P=.011). The difference between preoperative-postoperative Cobb angles in both groups was significant. The percentage of correction of Cobb-angle was 58.0% (AG) and 37.2% (PG) and this was statistically significant (P=.001). ODI was 7.2±6.4 (AG) and 11.4±12.4% (PG) and this was statistically insignificant (P=.061). Loss of correction was 1.0±1.4° (AG) and 2.9±2.5° (PG) and this was statistically significant (P=.016). Both-groups had similar followup (47.7±8.7 versus 48.7±10.1 weeks in AG and PG respectively). All patients achieved union and neurological recovery. Superficial infection occurred in 2 cases (PG) and lung parenchyma injury in one case (AG)