Posterior only versus combined posterior and anterior approaches in surgical management of lumbosacral tuberculosis with paraspinal abscess in adults

Purpose: To compare single-stage posterior transforaminal lumbar interbody fusion, debridement, posterior instrumentation, and postural drainage (posterior-only surgery) with a combined posterior-anterior surgical approach for treatment of adults with lumbosacral spinal tuberculosis (STB) with paraspinal abscess and to determine the clinical feasibility and effectiveness of posterior-only surgical treatment.

Methods: Thirty-nine patients with lumbosacral STB and paraspinal abscess were treated with one of two surgical procedures in our center from September 2003 to December 2012. Nineteen patients were treated with posterior-only surgery (Group A) and 20 were treated with combined posterior-anterior surgery (Group B). Surgery duration, intraoperative blood loss, length of hospitalization, bony fusion rates, complication rates, neurological status, lumbosacral angle correction, and Kirkaldy-Willis functional outcomes of the two groups were compared.

Results: The average follow-up period was 39.1 ± 12.0 months for Group A and 40.7 ± 12.4 months for Group B. Under the Frankel classification, all patients improved with treatment. STB was completely cured and grafted bones were fused within 5-11 months in all patients. There were no persistent or recurrent infections or obvious differences in radiological results between the groups. The lumbosacral angle was significantly corrected after surgical management, but loss of correction was seen in both groups. The average operative duration, blood loss, length of hospital stay, and postoperative complication rate of Group A were lower than those of Group B.

Conclusions: Posterior-only surgery is feasible and effective, resulting in better clinical outcomes than combined posterior-anterior surgeries, especially in surgical time, blood loss, hospital stay, and complications.