International Orthopaedics

, Volume 36, Issue 2, pp 345–351 | Cite as

Comparison between the antero-posterior and anterior approaches for treating L5-S1 vertebral tuberculosis

Original Paper

Abstract

Purpose

Both the antero-posterior and anterior approaches have been used for treating L5-S1 vertebral tuberculosis. However, no studies have compared the efficacy of the two methods in treating the disease.

Methods

The antero-posterior (AP group, 14 cases) and anterior (A group, 13 cases) approaches were performed on L5-S1 vertebral tuberculosis cases who were followed up for average of 25 months. Clinical and radiographic data were obtained from and compared between groups.

Results

Average operative time, blood loss and pre-operative, post-operative and last follow-up of lumbo-sacral angles for groups AP and A were 497 min vs 190 min, 980 ml vs 410 ml, 22.3° vs 20.6°, 29.8° vs 25.7° and 28.3° vs 23.6°, respectively. Averaged visual analogue scale (VAS) scores in groups AP and A, respectively, were 6.5 vs 6.0 points before surgery and 3.0 vs 2.8 points after surgery. Mean ODI scores were 60.2 vs 63.0 points before and 30.0 vs 28.5 points after the operation for groups AP and A, respectively. Six cases in the AP group and five in the A group who exhibited neurological symptoms recovered to American Spinal Injury Association (ASIA) grade E. The average hospitalisations of groups AP and A lasted for 21 and 15 days, respectively. Bony fusion was achieved in both groups, with an average fusion time of five and four months, respectively.

Conclusions

Both the antero-posterior and anterior approaches can effectively heal L5-S1 vertebral tuberculosis, but the average surgical time, blood loss and hospital stay following the anterior approach are prominently less than those following the antero-posterior approach.

Notes

Acknowledgement

This work was supported by grants from the National Natural Science Foundation of China (No.30300357, 39830100) and National High Technology Development Foundation of China (863) (No.2003AA205021, 2006AA02Z4E3, 2006AA02A122).

References

  1. 1.
    Wellons JC, Zomorodi AR, Villaviciencio AT, Woods CW, Lawson WT, Eastwood JD (2004) Sacral tuberculosis: a case report and review of the literature. Surg Neurol 61:136–139PubMedCrossRefGoogle Scholar
  2. 2.
    Moon MS, Moon YW, Moon JL, Kim SS, Sun DH (2002) Conservative treatment of tuberculosis of the lumbar and lumbosacral spine. Clin Orthop Relat Res 398:40–49PubMedCrossRefGoogle Scholar
  3. 3.
    Pun WK, Chow SP, Luk KD, Cheng CL, Hsu LC, Leong JC (1990) Tuberculosis of the lumbosacral junction. Long-term follow-up of 26 cases. J Bone Jt Surg Br 72:675–678Google Scholar
  4. 4.
    Sundararaj GD, Behera S, Ravi V, Venkatesh K, Cherian VM, Lee V (2003) Role of posterior stabilisation in the management of tuberculosis of the dorsal and lumbar spine. J Bone Jt Surg Br 85:100–106CrossRefGoogle Scholar
  5. 5.
    Jeanneret B, Magerl F (1994) Treatment of osteomyelitis of the spine using percutaneous suction/irrigation and percutaneous external spinal fixation. J Spinal Disord 7:185–205PubMedCrossRefGoogle Scholar
  6. 6.
    Ozturk C, Aydinli U, Vural R, Sehirlioglu A, Mutlu M (2007) Simultaneous versus sequential one-stage combined anterior and posterior spinal surgery for spinal infections (outcomes and complications). Int Orthop 31(3):363–366PubMedCrossRefGoogle Scholar
  7. 7.
    Oguz E, Sehirlioglu A, Altinmakas M, Ozturk C, Komurcu M, Solakoglu C, Vaccaro AR (2008) A new classification and guide for surgical treatment of spinal tuberculosis. Int Orthop 32(1):127–133PubMedCrossRefGoogle Scholar
  8. 8.
    Samuel S (2010) Comment on Oguz et al.: a new classification and guide for surgical treatment of spinal tuberculosis. Int Orthop 34(4):613PubMedCrossRefGoogle Scholar
  9. 9.
    Huang QS, Zheng C, Hu Y, Yin X, Xu H, Zhang G, Wang Q (2009) One-stage surgical management for children with spinal tuberculosis by anterior decompression and posterior instrumentation. Int Orthop 33(5):1385–1390PubMedCrossRefGoogle Scholar
  10. 10.
    Jain S (2010) Comment on Huang et al.: one-stage surgical management for children with spinal tuberculosis by anterior decompression and posterior instrumentation. Int Orthop 34(5):769–770PubMedCrossRefGoogle Scholar
  11. 11.
    Kim DJ, Yun YH, Moon SH, Riew KD (2004) Posterior instrumentation using compressive laminar hooks and anterior interbody arthrodesis for the treatment of tuberculosis of the lower lumbar spine. Spine (Phila Pa 1976) 29:E275–E279CrossRefGoogle Scholar
  12. 12.
    Klöckner C, Valencia R (2003) Sagittal alignment after anterior debridement and fusion with or without additional posterior instrumentation in the treatment of pyogenic and tuberculous spondylodiscitis. Spine (Phila Pa 1976) 28:1036–1042Google Scholar
  13. 13.
    Bhojraj S, Nene A (2002) Lumbar and lumbosacral tuberculous spondylodiscitis in adults. Redefining the indications for surgery. J Bone Joint Surg Br 84:530–534PubMedCrossRefGoogle Scholar
  14. 14.
    Zaveri GR, Mehta SS (2009) Surgical treatment of lumbar tuberculous spondylodiscitis by transforaminal lumbar interbody fusion (TLIF) and posterior instrumentation. J Spinal Disord Tech 22:257–262PubMedCrossRefGoogle Scholar
  15. 15.
    Bezer M, Kucukdurmaz F, Aydin N, Kocaoglu B, Guven O (2005) Tuberculous spondylitis of the lumbosacral region: long-term follow-up of patients treated by chemotherapy, transpedicular drainage, posterior instrumentation, and fusion. J Spinal Disord Tech 18:425–429PubMedCrossRefGoogle Scholar
  16. 16.
    Mukherjee SK, Dau AS (2007) Anterior lumbar fusion in Pott's disease. Clin Orthop Relat Res 460:93–99PubMedGoogle Scholar
  17. 17.
    Tribus CB, Belanger T (2001) The vascular anatomy anterior to the L5-S1 disk space. Spine 26:1205–1208PubMedCrossRefGoogle Scholar
  18. 18.
    Capellades J, Pellisé F, Rovira A, Grivé E, Pedraza S, Villanueva C (2000) Magnetic resonance anatomic study of iliocava junction and left iliac vein positions related to L5-S1 disc. Spine (Phila Pa 1976) 25:1695–1700CrossRefGoogle Scholar
  19. 19.
    Ha KY, Chung YG, Ryoo (2005) Adherence and biofilm formation of staphylococcus epidermidis and mycobacterium tuberculosis on various spinal implants. Spine 30:38–43PubMedCrossRefGoogle Scholar
  20. 20.
    Rajasekaran S, Soundarapandian S (1989) Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis. J Bone Joint Surg Am 71:1314–1323PubMedGoogle Scholar
  21. 21.
    Wenjun WANG, Bichun QUAN, Lile LIU (2005) The application of U shape titanium plate in surgical treatment of lumbar and sacrum spinal tuberculosis. Chin J Spine Spinal Cord 15:729–731Google Scholar
  22. 22.
    Lee SH, Sung JK, Park YM (2006) Single-stage transpedicular decompression and posterior instrumentation in treatment of thoracic and thoracolumbar spinal tuberculosis: a retrospective case series. J Spinal Disord Tech 19:595–602PubMedCrossRefGoogle Scholar
  23. 23.
    Güzey FK, Emel E, Bas NS, Hacisalihoglu S, Hacisalihoglu S, Seyithanoglu MH, Karacor SE, Ozkan N, Alatas I, Sel B (2005) Thoracic and lumbar tuberculous spondylitis treated by posterior debridement, graft placement, and instrumentation: a retrospective analysis in 19 cases. J Neurosurg Spine 3:450–458PubMedCrossRefGoogle Scholar
  24. 24.
    Korovessis P, Petsinis G, Koureas G, Iliopoulos P, Zacharatos S (2006) Anterior surgery with insertion of titanium mesh cage and posterior instrumented fusion performed sequentially on the same day under one anesthesia for septic spondylitis of thoracolumbar spine: is the use of titanium mesh cages safe? Spine 31:1014–1019PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.The Orthopedic Department, Southwest HospitalThird Military Medical UniversityChongqingPeople’s Republic of China

Personalised recommendations