title: Comparison of Three Surgical Approaches for Thoracic Spinal Tuberculosis in Adult: Minimum 5-Year Follow Up.
abstract: METHODS
  Retrospective study.
  
  
  OBJECTIVE
  To assess the minimum 5-year follow up outcomes of the surgical management of adults with thoracic tuberculosis by comparing posterior only (PO), anterior only (AO), and combined posterior and anterior (AP) surgical approaches.
  
  
  BACKGROUND
  Surgeons use multiple methods to treat spinal tuberculosis, including an anterior, posterior, and combined anterior and posterior approach. However, there are a few reports comparing the mid- and long-term outcomes of these surgical methods.
  
  
  METHODS
  The medical records for 184 patients treated for thoracic tuberculosis between January 2003 and November 2010 were retrospectively reviewed. Among them, 62 patients were treated with a single-stage posterior debridement and interbody fusion with instrumentation (Group A), 65 patients with posterior instrumentation, anterior debridement, and bone graft in a single or two-stage procedure (Group B), and 57 patients with anterior debridement and strut grafting with instrumentation (Group C). Operative time, blood loss, Visual Analog Scale for pain, complications, recovery of neurological function, Cobb angle, correction rate, and loss angle were compared among all groups.
  
  
  RESULTS
  Groups A, B, and C were followed for 72.7 ± 3.8 months, 74.3 ± 4.2 months, and 73.6 ± 4.5 months, respectively. The operative time, blood loss, and rate of complications for Group A were significantly less than Groups B and C (P < 0.05). The correction rate and loss angle were superior in Groups A and B compared with C, whereas the Visual Analog Scale for pain and fusion time showed no statistically significant difference among the groups (P > 0.05).
  
  
  CONCLUSIONS
  For patients with thoracic tuberculosis, use of the AO approach should be limited. Although the AP approach produced satisfactory outcomes, it remains more traumatic. Therefore, the PO approach is recommended, not only because it achieves good results, but because it has reduced complications, operative time, and blood loss.
  
  
  METHODS
  3.
authors: Department of Spine Surgery, Xiangya Hospital of Central-South University, Changsha, Hunan, China.
authors: Long-Jie
authors: LJ
authors: Wang
authors: Hong-Qi
authors: HQ
authors: Zhang
authors: Ming-Xing
authors: MX
authors: Tang
authors: Qi-le
authors: QL
authors: Gao
authors: Zhen-Hai
authors: ZH
authors: Zhou
authors: Xin-Hua
authors: XH
authors: Yin
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods*; D003646:Debridement / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000601:surgery*; D055815:Young Adult