Anterior versus posterior approach in surgical treatment of tuberculous spondylodiscitis of thoracic and lumbar spine
Anterior versus posterior approach in surgical treatment of tuberculous spondylodiscitis of thoracic and lumbar spine
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DOI：
10.1007/s00586-016-4451-2
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发表时间：
2016-04-01
影响因子：
2.8
通讯作者：
Elmorshidy, Essam
中科院分区：
文献类型：
--
作者：
Hassan, Khaled;Elmorshidy, Essam
本研究旨在比较前路与后路手术治疗胸腰椎结核性脊柱炎患者的临床、影像学和功能结局，共纳入42例胸腰椎结核性脊柱炎患者。A组20例，均行前路病灶清除、减压、内固定术。22例患者（B组）接受后外侧（腔外）减压和后路内固定术。对两组的手术参数、临床、影像学及功能结果进行分析和比较，两组的随访时间为12-24个月，平均15个月。前路组平均手术时间、术中出血量及输血量均明显少于后路组。后路组的背痛缓解、后凸角矫正和角度丢失均显著优于前路组。两组在神经功能恢复、功能结局和融合率方面无显著差异，前外侧和后外侧入路均足以实现胸腰椎Pott病的手术治疗目标，但后外侧入路可显著改善后凸角矫正，角度丢失较少，背痛改善更好，但不幸的是手术时间和失血量更多。
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.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.