Skip to main content


Log in

Anterior versus posterior approach in surgical treatment of tuberculous spondylodiscitis of thoracic and lumbar spine

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript



The aim of this study is to compare the clinical, radiological and functional outcome of anterior versus posterior surgical debridement and fixation in patients with thoracic and lumbar tuberculous spondylodiscitis.

Patients and methods

A total number of 42 patients with tuberculous spondylodiscitis of the thoracic and lumbar spine treated surgically were included in this study. Twenty patients (group A) underwent anterior debridement, decompression and instrumentation by anterior approach. Twenty-two patients (group B) were operated by posterolateral (extracavitary) decompression and posterior instrumentation. Operative parameters, clinical, radiographic and functional results for the two groups were analyzed and compared.


The average follow-up period was 15 months (range 12–24) in both groups. The average operative time, blood loss and blood transfusion of anterior group were significantly less than the posterior one. There was significant better back pain relief, kyphotic angle correction and less angle loss in the posterior group than anterior. There was no significant difference between the two groups regarding neurological recovery, functional outcome and fusion rate.


Both anterolateral and posterolateral approaches are sufficient for achieving the goals of surgical treatment of thoracic and lumbar Pott’s disease but posterolateral approach allows significant better kyphotic angle correction, less angle loss, better improvement in back pain but unfortunately more operative time and blood loss.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others


  1. Hodgson AR, Stock FE, Fang HS, Ong HS (1960) Anterior spinal fusion: the operative approach and pathological findings in 412 patients with Pott’s disease of the spine. Br J Surg 48:172–178

    Article  CAS  PubMed  Google Scholar 

  2. Luk KD (1999) Tuberculosis of the spine in the new millennium. Eur Spine J 8(5):338–345

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Benli T, Kaya A, Acaroglu E (2007) Anterior instrumentation in tuberculous spondylitis: is it effective and safe? Clin Orthop Relat Res 460:108–116

    PubMed  Google Scholar 

  4. Jain AK, Dhammi IK, Prashad B, Sinha S, Mishra P (2008) Simultaneous anterior decompression and posterior instrumentation of the tuberculous spine using an anterolateral extrapleural approach. J Bone Joint Surg (Br) 90:1477–1481

    Article  CAS  Google Scholar 

  5. Hee HT, Majd ME, Holt RT, Pienkowski D (2002) Better treatment of vertebral osteomylitis using posterior stabilization and titanium mesh cages. J Spinal Disord Tech 15:149–156

    Article  PubMed  Google Scholar 

  6. Krodel A, Kruger A, Lohscheidt Pfahler M, Refior HJ (1999) Anterior debridement, fusion, and extra focal stabilization in the treatment of osteomylitis of spine. J Spinal Disord 8:304–309

    Google Scholar 

  7. Fukata S, Miyamoto K, Masuda T, Hosoe H, Kodama H, Nishimoto H et al (2003) Two stage (posterior and anterior) surgical treatment using posterior spinal instrumentation for pyogenic and tuberculous spondylitis. Spine (Phila Pa 1976) 28:E302–E308

    Google Scholar 

  8. Moon MS, Woo YK, Lee KS, Ha KY, Kim SS, Sun DH (1995) Posterior instrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal and lumbar spines. Spine (Phila Pa 1976) 20:1910–1916

    Article  CAS  Google Scholar 

  9. Louw JA (1990) Spinal tuberculosis and neurological deficit: treatment with anterior vascularized rib graft, posterior osteotomies and fusion. J Bone Joint Surg (Br) 72:686–693

    CAS  Google Scholar 

  10. Jain AK, Aggarwal A, Dhammi IK, Aggrawal PK, Singh S (2004) Extra pleural anterolateral decompression in tuberculosis of the dorsal spine. J Bone Joint Surg (Br) 86:1027–1031

    Article  CAS  Google Scholar 

  11. Wang X, Pang X, Wu P, Luo C, Shen X (2014) One-stage anterior debridement, bone grafting and posterior instrumentation vs. single posterior debridement, bone grafting, and instrumentation for the treatment of thoracic and lumbar spinal tuberculosis. Eur Spine J 23(4):830–837

    Article  PubMed  PubMed Central  Google Scholar 

  12. Briggs M, Closs JS (1999) A distributive study of the use of visual analogue scales and vertebral rating scales for the assessment of postoperative pain in orthopedic pain. J Pain Symptom Manage 18:438–446

    Article  CAS  PubMed  Google Scholar 

  13. American Spinal Injury Association (1992) Standard for neurologic and functional classification of spinal cord injury. ASIA, Chicago

    Google Scholar 

  14. Brantigan JW (1994) Pseudoarthrosis rate after allograft posterior interbody fusion with pedicle screw and plate fixation. Spine 23(17):1829–1831

    Google Scholar 

  15. Bradford DS, McBride GG (1987) Surgical management of thoracolumbar spine fractures with incomplete neurologic deficits. Clin Orthop 218:201–216

    PubMed  Google Scholar 

  16. Fair JC, Pynsent PB (2000) The Oswestery disability index. Spine 25:2940–2952

    Article  Google Scholar 

  17. Moon M (1997) Tuberculosis of the spine. Controversies and a new challenge. Spine 22:1791–1797

    Article  CAS  PubMed  Google Scholar 

  18. Qureshi MA, Khalique AB, Afzal W, Pasha IF, Aebi M (2013) Surgical management of contiguous multilevel thoracolumbar tuberculous spondylitis. Eur Spine J 22(Suppl 4):618–623

    Article  PubMed  PubMed Central  Google Scholar 

  19. Tuli SM (2007) Tuberculosis of the spine: a historical review. Clin Orthop Relat Res 460:29–38

    CAS  PubMed  Google Scholar 

  20. Benli T, Acaroglu E, Akalin S, Kis M, Duman E, Un A (2003) Anterior radical debridement and anterior instrumentation in tuberculosis spondylitis. Eur Spine J 12(2):224–234

    PubMed  PubMed Central  Google Scholar 

  21. Jin D, Qu D, Chen J, Zhang H (2004) One-stage anterior interbody autografting and instrumentation in primary surgical management of thoracolumbar spinal tuberculosis. Eur Spine J 13(2):114–121

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lu G, Wang B, Li J, Liu W, Cheng I (2012) Anterior debridement and reconstruction via thoracoscopy-assisted mini-open approach for the treatment of thoracic spinal tuberculosis: minimum 5-year follow-up. Eur Spine J 21(3):463–469

    Article  PubMed  PubMed Central  Google Scholar 

  23. Jain AK, Dhammi IK (2007) Tuberculosis of the spine: a review. Clin Orthop Relat Res 460:39–49

    Article  PubMed  Google Scholar 

  24. Rajasekaran S, Soundarapandian S (1989) Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis. J Bone Joint Surg (Am) 71:1314–1323

    CAS  Google Scholar 

  25. Chew WJ, Wu CC, Jung CH, Chen LH, Niu CC, Lai P (2002) Combined anterior and posterior surgeries in the treatment of spinal tuberculous spondylitis. Clin Orthop Relat Res 398:50–59

    Article  Google Scholar 

  26. Yilmaz C, Selek HY, Gurkan I, Erdemli B, Kokusuz Z (1999) Anterior instrumentation for the treatment of spinal tuberculosis. J Bone Joint Surg (Am) 81:1261–1267

    CAS  Google Scholar 

  27. Faraj AA, Webb JK (2000) Spinal instrumentation for primary pyogenic infection: report of 31 patients. Acta Orthop Belg 66:242–247

    CAS  PubMed  Google Scholar 

  28. Oga M, Arizono T, Takasita M, Sugioka Y (1993) Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis: clinical and biologic study. Spine 18:1890–1894

    Article  CAS  PubMed  Google Scholar 

  29. Soultanis K, Mantelos G, Pagiatakis A, Soucacos PN (2003) Late infection in patients with scoliosis treated with spinal instrubentation. Clin Orthop Relat Res 441:116–123

    Article  Google Scholar 

  30. Ozdemir HM, Us AK, Ogun T (2003) The role of anterior spinal instrumentation and allograft fibula for the treatment of Pott’s disease. Spine (Phila Pa 1976) 28:474–479

    Google Scholar 

  31. Rajasekaran S, Rishi Mugesh KP, Setty AP (2011) Closing-opening wedge osteotomy for severe, rigid, thoracolumbar post-tubercular kyphosis. Eur Spine J 20(3):343–348

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Bhavuk G, Pankaj K, Upendra B, Ankeur G, Arvined J (2012) Anterior versus posterior procedure for surgical treatment of thoracolumbar tuberculosis: a retrospective analysis. Indian Orthop 46(2):165–170

    Article  Google Scholar 

Download references


No funds.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Essam Elmorshidy.

Ethics declarations

Conflict of interest


Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hassan, K., Elmorshidy, E. Anterior versus posterior approach in surgical treatment of tuberculous spondylodiscitis of thoracic and lumbar spine. Eur Spine J 25, 1056–1063 (2016).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: