Study on anterior and posterior approaches for spinal tuberculosis: a meta-analysis.

BACKGROUND: Timely and appropriate surgical intervention can enhance the stability of spine, eliminate the compression on spinal cord and prevent the further development the complications that may follow. However, there is no optimum surgical approach that has been agreed by surgeons.

OBJECTIVE: Incidence rate of spinal tuberculosis is still high in many developing countries. Except from chemotherapy, some patients require surgical treatment at certain phases of disease development. However, there is still not a standard operative procedure for spinal tuberculosis in the current research, and we studied the differences of anterior and posterior approach for spinal tuberculosis, to provide guidance for the further operative treatments.

METHODS: We searched "Pubmed" (2000.1-2014.7), "Medline" (2000.1-2014.7), "Elseveir" (2000.1-2014.7), Cochrane library (2008.1-2014.7), Wanfang (2000.1-2014.7), and CNKI (2000.1-2014.7) databases with the key words of "thoracolumbar tuberculosis", "controlled randomized trial", "RCT", "anterior" "posterior", and searched for randomized controlled trials for spinal tuberculosis. We compared the operative time, total blood loss, correction of Cobb angle, loss of Cobb angle at final follow-up, fusion time of allograft, time of total hospital stay, and the effectiveness of operative treatment between the anterior and posterior surgical approaches by Revman5.3 software.

RESULTS: From 1,523 papers found, we chose eight randomized controlled trials comparing different surgical approaches for the treatment of spinal tuberculosis. The total number of patients was 754, in which 377 were treated with anterior approach and 377 were treated with posterior approach correction of Cobb angle (P < 0.05), and no significant differences were found regarding operation time, loss of correction of Cobb angle in the last follow-up, time of total hospital stay, and fusion time of bone graft (P > 0.05).

CONCLUSIONS: There are significant differences between the two operative approaches regarding the correction of Cobb angle, but no significant differences regarding operation time, blood loss, loss of Cobb angle at the last follow-up, total fusion time, and length of total stay in the hospital.