Anterior versus posterior debridement fusion for single-level dorsal tuberculosis: the role of graft-type and level of fixation on determining the outcome

Purpose This study compared the clinical, radiological and functional outcome of anterior versus posterior approaches for single-level dorsal tuberculosis with analysis of effect of graft type and fixation level on the outcome. Methods Anterior group (AG): 43 cases (mean age: 49.5 years) fixed with Z-plate by anterior transthoracictranspleural approach. Posterior group (PG): 49 cases (47.0 years) fixed with transpedicular-screws with unilateral facetectomy +/- pediculectomy. Assessment was done using Frankel classification, blood-loss, operative-time, Kyphus-angle, correction loss, union and Oswestry disability index (ODI). Results Both groups had similar operative-time, bloodloss, time to union, follow-up, and hospital-stay. Kyphusangle improved from 36.6 +/- 8.4 +/- to 7.5 +/- 2.3 degrees (AG) and from 38.5 +/- 5.9 +/- to 11.1 +/- 3.6 +/- (PG) and this was significant. Postoperative Kyphus-angles were significantly better than preoperative ones in both groups. The correction percentage was 79.2 % (AG) and 69.9 % (PG) and this was significant. ODI was 3.4 +/- 4.1 (AG) and 3.0 +/- 4.2 % (PG) and this was insignificant. Correction loss was.8 +/- 1.2 degrees (AG) and 1.9 +/- 2.2 degrees (PG) and this was significant. Union was faster with iliac graft but with lower correction degree and higher correction loss than rib-strut graft. All patients achieved union. All but three patients achieved full neurological recovery. Superficial infection occurred in three cases (PG: 2; AG: 1) lung parenchymal injury in two case (AG), and DVT in one case (AG). Conclusions Both approaches give very good union and kyphosis correction rate that were maintained overtime. Anterior approach gives statistically better kyphosis correction and less correction-loss, but this is clinically insignificant. Besides, it is more risky and difficult. Strutgraft is essential in reconstruction and correction of kyphosis and vertebral height. Level of evidence III therapeutic.