title: Posterior only versus combined posterior and anterior approaches in surgical management of lumbosacral tuberculosis with paraspinal abscess in adults.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Spine Surgery, The Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan, 410008, People's Republic of China.
authors.forename: H
authors.initials: H
authors.lastname: Zeng
authors.affiliation: Department of Spine Surgery, The Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan, 410008, People's Republic of China. 2621132371@qq.com.
authors.forename: X
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Spine Surgery, The Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan, 410008, People's Republic of China.
authors.forename: X
authors.initials: X
authors.lastname: Pang
authors.affiliation: Department of Spine Surgery, The Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan, 410008, People's Republic of China.
authors.forename: C
authors.initials: C
authors.lastname: Luo
authors.affiliation: Department of Spine Surgery, The Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan, 410008, People's Republic of China.
authors.forename: P
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Department of Spine Surgery, The Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan, 410008, People's Republic of China.
authors.forename: W
authors.initials: W
authors.lastname: Peng
authors.affiliation: Department of Spine Surgery, The Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan, 410008, People's Republic of China.
authors.forename: P
authors.initials: P
authors.lastname: Wu
authors.affiliation: Department of Spine Surgery, The Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan, 410008, People's Republic of China.
authors.forename: Z
authors.initials: Z
authors.lastname: Xu
keywords: Lumbosacral spinal tuberculosis; Paraspinal abscess; Posterior-only approach; Postural drainage; Transforaminal lumbar interbody fusion (TLIF)
references.citation: Eur Spine J. 2013 Mar;22(3):624-32
references.pmid: 23053761
references.citation: Clin Orthop Relat Res. 1974 Mar-Apr;(99):30-50
references.pmid: 4274946
references.citation: Int Orthop. 2012 Feb;36(2):299-305
references.pmid: 22042304
references.citation: Br J Surg. 1960 Sep;48:172-8
references.pmid: 13714863
references.citation: Int Orthop. 2009 Oct;33(5):1407-14
references.pmid: 19052743
references.citation: Clin Orthop Relat Res. 2002 May;(398):40-9
references.pmid: 11964630
references.citation: Int J Tuberc Lung Dis. 2013 Feb;17(2):229-33
references.pmid: 23317959
references.citation: Arch Orthop Trauma Surg. 2012 Oct;132(10 ):1429-35
references.pmid: 22736022
references.citation: Arch Orthop Trauma Surg. 2013 Mar;133(3):333-41
references.pmid: 23242452
references.citation: Patient Saf Surg. 2009 Feb 25;3(1):4
references.pmid: 19243602
references.citation: Arch Orthop Trauma Surg. 2013 Jun;133(6):765-72
references.pmid: 23503890
references.citation: Spine (Phila Pa 1976). 1995 Feb 1;20(3):356-61
references.pmid: 7732473
references.citation: Int Orthop. 2009 Oct;33(5):1385-90
references.pmid: 19340427
references.citation: Clin Orthop Relat Res. 1992 Nov;(284):34-46
references.pmid: 1395312
references.citation: J Bone Joint Surg Br. 2002 May;84(4):530-4
references.pmid: 12043773
references.citation: J Bone Joint Surg Am. 1972 Dec;54(8):1633-57
references.pmid: 4569464
references.citation: J Spinal Disord Tech. 2013 Jul;26(5):233-8
references.pmid: 22214928
references.citation: J Spinal Disord Tech. 2006 Dec;19(8):554-9
references.pmid: 17146297
references.citation: Eur J Pediatr. 1999 Dec;158(12 ):1003-4
references.pmid: 10592079
references.citation: Kobe J Med Sci. 2000 Apr;46(1-2):39-68
references.pmid: 11193503
references.citation: Eur Spine J. 2003 Apr;12 (2):224-34
references.pmid: 12709862
references.citation: Leg Med (Tokyo). 2010 Sep;12(5):223-7
references.pmid: 20630786
references.citation: Paraplegia. 1969 Nov;7(3):179-92
references.pmid: 5360915
references.citation: Man Ther. 2012 Aug;17(4):e7; author reply e8-9
references.pmid: 22015372
references.citation: Int Orthop. 2007 Dec;31(6):859-63
references.pmid: 17061127
references.citation: J Spinal Disord Tech. 2012 Oct;25(7):E217-23
references.pmid: 22854920
references.citation: J Orthop Res. 2012 Oct;30(10):1577-80
references.pmid: 22488899
references.citation: Acta Radiol. 1996 Jul;37(4):506-11
references.pmid: 8688231
references.citation: J Bone Joint Surg Br. 2007 Oct;89(10 ):1379-81
references.pmid: 17957082
references.citation: Spine (Phila Pa 1976). 2003 May 15;28(10 ):1036-42
references.pmid: 12768146
references.citation: Spine (Phila Pa 1976). 1998 May 15;23 (10 ):1163-7
references.pmid: 9615369
references.citation: Orthop Surg. 2010 Feb;2(1):64-70
references.pmid: 22009910
references.citation: J Neurosurg Spine. 2007 Nov;7(5):542-8
references.pmid: 17977197
references.citation: J Anat. 2012 Dec;221(6):537-67
references.pmid: 22994881
references.citation: Arch Orthop Trauma Surg. 2012 Dec;132(12):1677-83
references.pmid: 22933051
references.citation: Am J Phys Anthropol. 1987 Mar;72 (3):361-72
references.pmid: 3107397
references.citation: Int Orthop. 2010 Jun;34(5):769-70; author relply 771
references.pmid: 20174795