Advertisement

Anterior versus posterior instrumentation for treatment of thoracolumbar tuberculosis

A meta-analysis
  • Kai Wang
  • Na Wang
  • Yuliang Wang
  • Yayi Xia
  • Feixue Song
  • Jingsheng Liu
Originalien

Abstract

Background

To compare clinical and functional outcomes of anterior versus posterior debridement and spinal fixation for surgical treatment of thoracolumbar tuberculosis.

Methods

A computer-based online search of the Cochrane Library, PubMed, EMBase, Wanfang, VIP, and the CNKI database was performed. The methodological quality of included studies was evaluated, and data analyses were performed using RevMan 5.0 software (The Nordic Cochrane Centre, The Cochrane Collaboration Copenhagen, Denmark).

Results

Eleven trials were studied, with eight performed in China, two in Egypt, and one in India. The results showed significant differences between the two operative approaches in terms of correction of kyphotic angle and intraoperative blood loss, but not in terms of operation time, hospital stay, fusion time, and loss of correction at the final follow-up.

Conclusion

The anterior and posterior approaches are equally good methods for treatment of thoracolumbar tuberculosis. The anterior approach results in less blood loss, whereas posterior instrumentation is better suited for correction of kyphotic angle.

Keywords

Kyphosis Controlled clinical trials, randomized Debridement Blood loss, surgical Length of stay 

Abbreviations

CI

Confidence intervals

RR

Relative risk

SMD

Standard mean difference

TB

Tuberculosis

WMD

Weighted mean difference

Anteriore vs. posteriore Instrumentierung zur Therapie der thorakolumbalen Tuberkulose

Eine Metaanalyse

Zusammenfassung

Hintergrund

Ziel war der Vergleich klinischer und funktioneller Ergebnisse des anterioren gegenüber dem posterioren Débridement und der spinalen Fixation als chirurgische Behandlung der thorakolumbalen Tuberkulose.

Methoden

Eine computerbasierte Onlinerecherche in den Datenbanken Cochrane Library, PubMed, EMBase, Wanfang, VIP und CNKI wurde durchgeführt. Die methodologische Qualität der einbezogenen Studien wurde bewertet und Datenanalysen unter Verwendung der Software RevMan 5.0 (The Nordic Cochrane Centre, The Cochrane Collaboration, Kopenhagen, Dänemark) ausgeführt.

Ergebnisse

Es wurden 11 Studien untersucht, 8 davon waren in China, 2 in Ägypten und eine in Indien durchgeführt worden. Die Ergebnisse wiesen signifikante Unterschiede zwischen den beiden operativen Ansätzen in Bezug auf die Korrektur des Kyphosewinkels und den intraoperativen Blutverlust auf, nicht jedoch in Bezug auf die Operationsdauer, die Krankenhausverweildauer, die Dauer bis zur Fusion und einen Verlust der Korrektur bei der abschließenden Nachuntersuchung.

Schlussfolgerung

Der anteriore und posteriore Ansatz sind gleich gute Verfahren zur Therapie der thorakolumbalen Tuberkulose. Bei dem anterioren Ansatz kommt es zu einem geringeren Blutverlust, während die posteriore Instrumentierung sich besser zur Korrektur des Kyphosewinkels eignet.

Schlüsselwörter

Kyphose Kontrollierte klinische Studien, randomisierte Débridement Blutverlust, intraoperativer Verweildauer 

Notes

Compliance with ethical guidelines

Conflict of interest

K. Wang, N. Wang, Y. Wang, Y. Xia, F. Song, and J. Liu declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors. Institutional review board approval and patient consent were not required for this meta-analysis of observational studies.

References

  1. 1.
    Alam MS, Phan K, Karim R et al (2015) Surgery for spinal tuberculosis: a multi-center experience of 582 cases. J Spine Surg 1(1):65–71Google Scholar
  2. 2.
    Turgut M (2001) Spinal tuberculosis (Pott’s disease): its clinical presentation, surgical management, and outcome. A survey study on 694 patients. Neurosurg Rev 24(4):8–13CrossRefGoogle Scholar
  3. 3.
    Zhu WJ, Ding LH, Sun XL et al (2012) Anterior debridement bone graft and posterior internal fixation in the treatment of thoraciclumbar spinal tuberculosis. J Jiangsu Univ Med Ed 22(2):145Google Scholar
  4. 4.
    Rajasekaran S (2012) Kyphotic deformity in spinal tuberculosis and its management. Int Orthop 36(2):359–365CrossRefGoogle Scholar
  5. 5.
    Issack PS, Boachie-Adjei O (2012) Surgical correction of kyphotic deformity in spinal tuberculosis. Int Orthop 36(2):353–357CrossRefGoogle Scholar
  6. 6.
    Soares Do Brito J, Tirado A, Fernandes P (2014) Surgical treatment of spinal tuberculosis complicated with extensive abscess. Iowa Orthop J 34:129–136Google Scholar
  7. 7.
    Yang P, Zang Q, Kang J et al (2016) Comparison of clinical efficacy and safety among three surgical approaches for the treatment of spinal tuberculosis: a meta-analysis. Eur Spine J 25(12):3862–3874CrossRefGoogle Scholar
  8. 8.
    Lee TC, Lu K, Yang LC et al (1999) Transpedicular instrumentation as an adjunct in the treatment of thoracolumbar and lumbar spine tuberculosis with early stage bone destruction. J Neurosurg 91(2 Suppl):163–169Google Scholar
  9. 9.
    Zaveri G (2011) The role of posterior surgery in spinal tuberculosis. Argospine News J 23(3):112–119CrossRefGoogle Scholar
  10. 10.
    Wang XB, Li J, Lü GH et al (2012) Single-stage posterior instrumentation and anterior debridement for active tuberculosis of the thoracic and lumbar spine with kyphotic deformity. Int Orthop 36(2):373–380CrossRefGoogle Scholar
  11. 11.
    Vamvanij V, Ruangchainikom M, Thanapipatsiri S et al (2014) The outcomes of combined posterior instrumentation and anterior radical debridement with fusion for multilevel spinal tuberculosis. J Med Assoc Thai 97(Suppl 9):S50–S55Google Scholar
  12. 12.
    Garg B, Kandwal P, Nagaraja UB et al (2012) Anterior versus posterior procedure for surgical treatment of thoracolumbar tuberculosis: a retrospective analysis. Indian J Orthop 46(2):165–170CrossRefGoogle Scholar
  13. 13.
    Li G, Du XH, Liu KY (2014) Effect of anterior and posterior internal fiation on one-stage radical debridement and bone graft fusion in spinal tuberculosis. Lab Med Cli 11(1):52–54CrossRefGoogle Scholar
  14. 14.
    Hassan K, Elmorshidy E (2016) Anterior versus posterior approach in surgical treatment of tuberculous spondylodiscitis of thoracic and lumbar spine. Eur Spine J 25(4):1056–1063CrossRefGoogle Scholar
  15. 15.
    Li SF, Huang XW, Liu XY et al (2012) Comparative analysis of efficacy of anterior and posterior debridement in treatment of lumbar vertebral tuberculosis. China Med Her 9(3):69–70Google Scholar
  16. 16.
    Pu X, Zhou Q, He Q et al (2012) A posterior versus anterior surgical approach in combination with debridement, interbody autografting and instrumentation for thoracic and lumbar tuberculosis. Int Orthop 36(2):307–313CrossRefGoogle Scholar
  17. 17.
    Cai XQ, Dong WJ (2013) Study on the effect of orthopedic and rehabilitation of anterior fixation and posterior fixation in the treatment of spinal tuberculosis. China Mod Med 20(14):11–13Google Scholar
  18. 18.
    Cui X, Ma YZ, Li HW et al (2012) Outcomes of anterior vrsus posterior instrumentation under different surgical procedures in the treatment of thoracolumbar spinal tuberculosis in adults. Natl Med J China 92(19):1325–1329Google Scholar
  19. 19.
    Assaghir YM, Refae HH, Alam-Eddin M (2016) Anterior versus posterior debridement fusion for single-level dorsal tuberculosis: the role of graft-type and level of fixation on determining the outcome. Eur Spine J 25(12):3884–3893CrossRefGoogle Scholar
  20. 20.
    Man YW, Tang E, Tang YT et al (2012) Comparative study on anterior and posterior fixation in the treatment of lumbar spinal tuberculosis. China Mod Med 19(3):42–43Google Scholar
  21. 21.
    Ma YZ, Cui X, Li HW et al (2012) Outcomes of anterior and posterior instrumentation under different surgical procedures for treating thoracic and lumbar spinal tuberculosis in adults. Int Orthop 36(2):299–305CrossRefGoogle Scholar
  22. 22.
    Yang ZP (2016) The observation of anterior and posterior internal fixation for thoracic lumbar spinal tuberculosis. World Latest Med Inf 16(58):116Google Scholar
  23. 23.
    Nagashima H, Yamane K, Nishi T et al (2010) Recent trends in spinal infections: retrospective analysis of patients treated during the past 50 years. Int Orthop 34(3):395–399CrossRefGoogle Scholar
  24. 24.
    Jin D, Qu D, Chen J et al (2004) One-stage anterior interbody autografting and instrumentation in primary surgical management of thoracolumbar spinal tuberculosis. Eur Spine J 13(2):114–121CrossRefGoogle Scholar
  25. 25.
    Yang X, Huo H, Xiao Y et al (2010) Function reconstruction of anteriorand middle column in thoracolumbar spinal tuberculosis by one-stage anterior radical debridement. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 24(1):37–40Google Scholar
  26. 26.
    Jain AK, Dhammi IK, Prashad B et al (2008) Simultaneous anterior decompression and posterior instrumentation of the tuberculous spine using an anterolateral extrapleural approach. J Bone Joint Surg Br 90:1477–1481CrossRefGoogle Scholar
  27. 27.
    Hee HT, Majd ME, Holt RT et al (2002) Better treatment of vertebral osteomyelitis using posteriorstabilization and titanium mesh cages. J Spinal Disord Tech 15(2):149–156CrossRefGoogle Scholar
  28. 28.
    Fukuta S, Miyamoto K, Masuda T et al (2003) Two-stage (posterior and anterior) surgical treatment using posterior spinal instrumentation for pyogenic and tuberculotic spondylitis. Spine (Phila Pa 1976) 28(15):E302–E308Google Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • Kai Wang
    • 1
  • Na Wang
    • 2
  • Yuliang Wang
    • 1
  • Yayi Xia
    • 1
  • Feixue Song
    • 2
  • Jingsheng Liu
    • 1
  1. 1.Department of OrthopedicsSecond Hospital of Lanzhou UniversityLanzhouChina
  2. 2.Department of OncologySecond Hospital of Lanzhou UniversityLanzhouChina

Personalised recommendations