Comparison between the antero-posterior and anterior approaches for treating L5-S1 vertebral tuberculosis

Both the antero-posterior and anterior approaches have been used for treating L5-S1 vertebral tuberculosis. However, no studies have compared the efficacy of the two methods in treating the disease.

The antero-posterior (AP group, 14 cases) and anterior (A group, 13 cases) approaches were performed on L5-S1 vertebral tuberculosis cases who were followed up for average of 25 months. Clinical and radiographic data were obtained from and compared between groups.

Average operative time, blood loss and pre-operative, post-operative and last follow-up of lumbo-sacral angles for groups AP and A were 497 min vs 190 min, 980 ml vs 410 ml, 22.3° vs 20.6°, 29.8° vs 25.7° and 28.3° vs 23.6°, respectively. Averaged visual analogue scale (VAS) scores in groups AP and A, respectively, were 6.5 vs 6.0 points before surgery and 3.0 vs 2.8 points after surgery. Mean ODI scores were 60.2 vs 63.0 points before and 30.0 vs 28.5 points after the operation for groups AP and A, respectively. Six cases in the AP group and five in the A group who exhibited neurological symptoms recovered to American Spinal Injury Association (ASIA) grade E. The average hospitalisations of groups AP and A lasted for 21 and 15 days, respectively. Bony fusion was achieved in both groups, with an average fusion time of five and four months, respectively.

Both the antero-posterior and anterior approaches can effectively heal L5-S1 vertebral tuberculosis, but the average surgical time, blood loss and hospital stay following the anterior approach are prominently less than those following the antero-posterior approach.