title: Posterior only versus combined posterior and anterior approaches for lower lumbar tuberculous spondylitis with neurological deficits in the aged.
abstract: METHODS
  Retrospective case-control study.
  
  
  OBJECTIVE
  To analyze the results of two surgical treatments for lower lumbar tuberculous spondylitis with neurological deficits in the aged.
  
  
  METHODS
  We studied 33 cases of lower lumbar spinal tuberculous spondylitis treated in our center from January 2006 to October 2010. The cases were divided into two groups: 16 cases (group A) underwent single- or two-stage anterior debridement, bone grafting and posterior instrumentation, and 17 cases (group B) underwent single-stage posterior debridement, decompression, interbody fusion and instrumentation. Clinical and radiographic results were analyzed and compared between the groups.
  
  
  RESULTS
  Patients were followed for a mean of 41.3 months (range 36-48 months). The average operative durations were 276.9±23.8 and 193.8±22.5 min in groups A and B, respectively. The average hospital stay was 18.2±3.2 days for group A and 13.4±1.6 days for group B. Average intraoperative blood loss for groups A and B was 1187.5±163.0 and 804.7±134.1 ml, respectively. Operative complications affected four patients in group A and one in group B. Solid fusion occurred at 12 months in the other 32 cases. Neurological status was significantly improved in all cases. Kyphosis was significantly corrected after surgical management, but loss of correction occurred in both groups.
  
  
  CONCLUSIONS
  Single-stage posterior debridement, decompression, interbody fusion and instrumentation might be a better surgical treatment than combined posterior and anterior approaches for lower lumbar tuberculous spondylitis with neurological deficits in the aged, offering fewer complications and a better quality of life.
authors: Department of Spine Surgery, The Xiangya Hospital of Central South University, Changsha, Hunan, China.
authors: Z
authors: Z
authors: Xu
authors: Department of Spine Surgery, The Xiangya Hospital of Central South University, Changsha, Hunan, China.
authors: X
authors: X
authors: Wang
authors: Department of Spine Surgery, The People's Hospital of Hunan Province, Changsha, Hunan, China.
authors: X
authors: X
authors: Shen
authors: Department of Spine Surgery, The Xiangya Hospital of Central South University, Changsha, Hunan, China.
authors: C
authors: C
authors: Luo
authors: Department of Spine Surgery, The Xiangya Hospital of Central South University, Changsha, Hunan, China.
authors: H
authors: H
authors: Zeng
authors: Department of Spine Surgery, The Xiangya Hospital of Central South University, Changsha, Hunan, China.
authors: P
authors: P
authors: Zhang
authors: Department of Spine Surgery, The Xiangya Hospital of Central South University, Changsha, Hunan, China.
authors: W
authors: W
authors: Peng
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods*; D016022:Case-Control Studies; D003646:Debridement / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000209:etiology / Q000473:pathology; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D014399:Tuberculosis, Spinal / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*