Posterior-only versus combined posterior-anterior approaches for thoracolumbar spinal tuberculosis with neurological deficit in the elderly

Objectives: This retrospective case-control study aimed to compare two surgical approaches (posterioronly versus combined posterior-anterior) for treating thoracolumbar (T11-L2) spinal tuberculosis with neurological deficits, and to evaluate the clinical effectiveness of posterior-only surgery in the elderly patients. Patients and Methods: We retrospectively reviewed 30 cases of thoracolumbar spinal tuberculosis with neurological deficits between October 2009 and May 2014, including 16 cases treated with single-stage posterior debridement, decompression, interbody fusion, and instrumentation (group A). The other 14 cases treated with single or two-stage anterior debridement, bone grafting, and posterior instrumentation (group B). The clinical and radiographic outcomes were analyzed and compared. Results: The mean operative durations were 153.1 +/- 18.5 minutes and 276.4 +/- 17.4 minutes in groups A and B, respectively (p<0.05). The average hospital stay time was 13.6 +/- 1.5 days for group A and 18.6 +/- 3.4 days for group B (p<0.05). Average intraoperative blood loss volume was 781.3 +/- 155.9 mL and 1250.0 +/- 174.3 mL for groups A and B, respectively (p<0.05). All patients were followed up for an average of 41.2 +/- 4.4 months (range 36-48 months). Bony fusion occurred after an average of 8.5 +/- 1.6 months and 8.1 +/- 1.9 months in groups A and B, respectively. The Cobb angle was significantly decreased in both groups after surgical treatment, but loss of correction occurred in both groups. Neurological status was significantly improved post-operatively in all cases (p<0.05). Conclusion: Posterior-only approach may result in fewer complications and provide a better quality of life than combined posterior-anterior approaches for thoracolumbar spinal tuberculosis with neurological deficits in the elderly.