title: Anterior versus posterior procedure for surgical treatment of thoracolumbar tuberculosis: A retrospective analysis.
abstract: BACKGROUND
  Approach for surgical treatment of thoracolumbar tuberculosis has been controversial. The aim of present study is to compare the clinical, radiological and functional outcome of anterior versus posterior debridement and spinal fixation for the surgical treatment of thoracic and thoracolumbar tuberculosis.
  
  
  METHODS
  70 patients with spinal tuberculosis treated surgically between Jan 2005 and Dec 2009 were included in the study [corrected]. Thirty four patients (group I) with mean age 34.9 years underwent anterior debridement, decompression and instrumentation by anterior transthoracic, transpleural and/or retroperitoneal diaphragm cutting approach. Thirty six patients (group II) with mean age of 33.6 years were operated by posterolateral (extracavitary) decompression and posterior instrumentation. Various parameters like blood loss, surgical time, levels of instrumentation, neurological recovery, and kyphosis improvement were compared. Fusion assessment was done as per Bridwell criteria. Functional outcome was assessed using Prolo scale. Mean followup was 26 months.
  
  
  RESULTS
  Mean surgical time in group I was 5 h 10 min versus 4 h 50 min in group II (P>0.05). Average blood loss in group I was 900 ml compared to 1100 ml in group II (P>0.05). In group I, the percentage immediate correction in kyphosis was 52.27% versus 72.80% in group II. Satisfactory bony fusion (grades I and II) was seen in 100% patients in group I versus 97.22% in group II. Three patients in group I needed prolonged immediate postoperative ICU support compared to one in group II. Injury to lung parenchyma was seen in one patient in group I while the anterior procedure had to be abandoned in one case due to pleural adhesions. Functional outcome (Prolo scale) in group II was good in 94.4% patients compared to 88.23% patients in group I.
  
  
  CONCLUSIONS
  Though the anterior approach is an equally good method for debridement and stabilization, kyphus correction is better with posterior instrumentation and the posterior approach is associated with less morbidity and complications.
authors.affiliation: Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
authors.forename: Bhavuk
authors.initials: B
authors.lastname: Garg
authors.forename: Pankaj
authors.initials: P
authors.lastname: Kandwal
authors.forename: Upendra Bidre
authors.initials: UB
authors.lastname: Nagaraja
authors.forename: Ankur
authors.initials: A
authors.lastname: Goswami
authors.forename: Arvind
authors.initials: A
authors.lastname: Jayaswal