Posterior only versus combined posterior and anterior approaches in surgical management of lumbosacr

• 作 者: H.Zeng X.Wang X.Pang C.Luo P.Zhang W.Peng P.Wu Z.Xu
• 机 构: Department of Spine Surgery, The Xiangya Hospital of Central South University, 87＃ Xiangya Road, Cha
• 出 处: 第三届全国脊柱结核诊疗新技术研讨会暨2017年湖南省医学会脊柱外科专业委员会年会
• 发表日期: 2017年8期
• 关键词: Lumbosacral spinal tuberculosis Posterior-only approach Transforaminal lumbar in

　　Purpose To compare single-stage posterior transforami-nal 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 deter-mine 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 Decem-ber 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,lum-bosacral 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 com-bined posterior-anterior surgeries,especially in surgical time,blood loss,hospital stay,and complications.