title: Efficacy and Safety of Posterior Versus Combined Posterior and Anterior Approach for the Treatment of Spinal Tuberculosis: A Meta-Analysis.
abstract: OBJECTIVE
  Surgical treatment is an important strategy for the treatment of spinal tuberculosis (TB). Several approaches have been reported for the surgery. However, no single study has had a large enough sample population to definitively determine whether the single posterior approach is as effective and safe as the combined posterior and anterior approach for the treatment of spinal TB. A meta-analysis was conducted to evaluate the clinical efficacy and safety of posterior versus combined posterior and anterior approach for the treatment of spinal TB.
  
  
  METHODS
  In this meta-analysis, electronic databases, such as PubMed, MEDLINE, EMBASE, Google scholar, and Cochrane library, were searched to select the potentially relevant reports that compared the outcomes of the posterior approach (group A) with the combined posterior and anterior approach (group B) in the treatment of spinal TB. Relevant journals and references were also searched manually. Data extraction and quality assessment were according with Cochrane Collaboration guidelines. Outcome assessments were operation time, blood loss, correction of angle, loss of correction, hospital stay, fusion time of the grafting bone, neurological improvement, and complications after surgery. Results were expressed as odds ratio for dichotomous outcomes and mean difference for continuous outcomes with 95% confidence interval.
  
  
  RESULTS
  Five controlled clinical trials published between 2012 and 2014, involving 253 patients (group A, 129; group B, 124) with spinal TB were retrieved in this study. The overall meta-analysis showed that there were significant differences (P< 0.01) between groups A and B in operation time, blood loss, hospital stay, and complications after surgery. However, no significant differences (P> 0.05) were observed in correction of angle, loss of correction at the final follow-up, fusion time of the grafting bone, and neurological improvement after surgery between groups A and B.
  
  
  CONCLUSIONS
  The posterior approach appeared to have the same clinical efficacy, but with less operation time, blood loss, hospital stay, and complications compared with the combined posterior and anterior approach in the treatment of sinal TB. However, more high-quality, randomized controlled trials are required to compare these approaches and guide clinical decision-making.
authors.affiliation: Department of Orthopedics Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China.
authors.forename: Jiaming
authors.initials: J
authors.lastname: Liu
authors.affiliation: Scientific Research Department, Jiangxi Vocational and Technical College of Information Application, Nanchang, People's Republic of China.
authors.forename: Linyue
authors.initials: L
authors.lastname: Wan
authors.affiliation: Department of Orthopedics Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China.
authors.forename: Xinhua
authors.initials: X
authors.lastname: Long
authors.affiliation: Department of Orthopedics Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China.
authors.forename: Shanhu
authors.initials: S
authors.lastname: Huang
authors.affiliation: Department of Orthopedics Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China.
authors.forename: Min
authors.initials: M
authors.lastname: Dai
authors.affiliation: Department of Orthopedics Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China. Electronic address: zgm7977@163.com.
authors.forename: Zhili
authors.initials: Z
authors.lastname: Liu
mesh_terms: D016063:Blood Loss, Surgical; D002986:Clinical Trials as Topic; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016017:Odds Ratio; D061646:Operative Time; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods; D020127:Recovery of Function; D058028:Research Report / Q000592:standards*; D016103:Spinal Fractures / Q000382:microbiology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013131:Spine / Q000382:microbiology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000503:physiopathology* / Q000601:surgery*
keywords: Meta-analysis; Posterior and anterior approach; Posterior approach; Spinal tuberculosis