Anterior versus Posterior Approaches with One-Stage Debridement and Bone Grafting for Surgical Treatment of Spinal Tuberculosis: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 ABASI-Aimaiti ,  MAIERDAN-Maimaiti , SHENGWei-bin

Department of Orthopedics, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China;

Corresponding author：

MAIERDAN-Maimaiti, Email: mardanmmtmx@163.com

Keywords：

Spinal tuberculosis; Anterior instrumentation; Posterior instrumentation; Meta-Analysis; Systematic review

DOI：

10.7507/1672-2531.20150213

Video：

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Objective To systematically evaluate the effectiveness of anterior versus posterior approaches with one-stage debridement and bone grafting for surgical treatment of spinal tuberculosis. Methods Databases including PubMed, MEDLINE, Ovid, Elsevier, CBM, WanFang Data, CNKI and VIP were electronically searched from 2004 to 2015 to collect relevant clinical studies about the effectiveness of anterior versus posterior approaches with one-stage debridement and bone grafting for surgical treatment of spinal tuberculosis. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies, and then meta-analysis was performed using RevMan 5.2 software. Results A total of 11 studies involving 1 063 patients were included. The results of meta-analysis showed that: correction of Cobb angle with the posterior approach was significantly larger than that of anterior approach (MD=-2.78, 95%CI -3.73 to -1.82, P<0.000 01); the allograft fusion time of anterior approach was shorter than that of posterior approach (MD=-0.21, 95%CI -0.35 to -0.08, P=0.002). But there were no significant differences between the two groups in operation time, intraoprative blood loss, loss of Cobb angle at final follow-up and time of total hospital stay (all P values >0.05). Conclusion Posterior approach can correct the Cobb angle significantly for the spinal tuberculosis patients with kyphosis, and anterior approach has a shorter allograft fusion time, but it is not able to correct the deformity of the patient to maintain the normal sequence of the spine. For the quantity and quality limitation of the included studies, this conclusion still needs to be proved by conducting more high quality studies.

Citation： ABASI-Aimaiti, MAIERDAN-Maimaiti, SHENGWei-bin. Anterior versus Posterior Approaches with One-Stage Debridement and Bone Grafting for Surgical Treatment of Spinal Tuberculosis: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2015, 15(11): 1293-1300. doi: 10.7507/1672-2531.20150213 Copy

1.	Ibrahim A, Lee KY, Kanoo LL, et al. Epidemiology of spinal cord injury in Hospital Kuala Lumpur. J Spine (Phila Pa1976), 2013, 38(5): 419-424.
2.	么鸿雁, 刘剑君. 遏制结核病策略(WHO 2005.9). 结核病健康教育, 2006, (1):35-43.
3.	张宏其, 田惠忠. 脊柱结核手术学. 广州:广东科技出版, 2014: 1728.
4.	Furlan AD, Pennick V, Bombardier C, et al. 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. J Spine (Phila Pa 1976), 2009, 34(18):1929-1941.
5.	Zeng X, Zhang Y, Kwong JS, et al. The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline:a systematic review. J Evid Based Med, 2015, 8(1):2-10.
6.	蔡希强, 董伟杰. 前路固定与后路固定治疗脊柱结核的矫形及神经康复效果研究. 中国当代医药, 2013, 20(14):11-13.
7.	Garg B, Kandwal P, Nagaraja UB, et al. Anterior versus posterior procedure for surgical treatment of thoracolumbar tuberculosis:A retrospective analysis. J Indian J Orthop, 2012, 46(2):165-170.
8.	Ma YZ, Cui X, Li HW, et al. Outcomes of anterior and posterior instrumentation under different surgical procedures for treating thoracic and lumbar spinal tuberculosis in adults. J Int Orthop, 2012, 36(2):299-305.
9.	Pu X, Zhou Q, He Q, et al. A posterior versus anterior surgical approach in combination with debridement, interbody autografting and instrumentation for thoracic and lumbar tuberculosis. J Int Orthop, 2012, 36(2):307-313.
10.	Zhang HQ, Li JS, Zhao SS, et al. Surgical management for thoracic spinal tuberculosis in the elderly:posterior only versus combined posterior and anterior approaches. J Arch Orthop Trauma Surg, 2012, 132(12):1717-1723.
11.	Zhong W, Xiong G, Wang B, et al. Surgical management for thoracic spinal tuberculosis posterior only versus anterior video-assisted thoracoscopic surgery. PLoS One, 2015, 10(3):e119759.
12.	周树根, 陈少慧, 温干军, 等. 脊柱结核前后路不同术式的选择及疗效分析. 中国医药科学, 2014, 4(5):201-203.
13.	周焯家, 简月奎, 李波, 等. 腰骶椎结核治疗的方法选择(附65例分析). 中国矫形外科杂志, 2008, 16(15):1141-1143.
14.	崔旭, 马远征, 陈兴, 等. 脊柱结核前后路不同术式的选择及其疗效. 中国脊柱脊髓杂志, 2011, 21(10):807-812.
15.	崔旭, 马远征, 李宏伟, 等. 前路和后路内固定治疗胸腰椎结核的疗效比较. 中华医学杂志, 2012, 92(19):1325-1329.
16.	满益旺, 唐接福, 唐永太, 等. 前、后路内固定手术治疗胸腰段脊柱结核的对比研究. 中国当代医药, 2012, 19(3):42-43.
17.	Jain AK, Dhammi IK, Prashad B, et al. Simultaneous anterior decompression and posterior instrumentation of the tuberculous spine using an anterolateral extrapleural approach. J Bone Joint Surg Br, 2008, 90(11):1477-1481.
18.	Rajasekaran S, Shanmugasundaram TK. Prediction of the angle of gibbus deformity in tuberculosis of the spine. J Bone Joint Surg Am, 1987, 69(4):503-509.
19.	Flynn JC, Hoque MA. Anterior fusion of the lumbar spine. Endresult study with long-term follow-up. J Bone Joint Surg Am, 1979, 61(8):1143-1150.
20.	Nakai S, Zielke K. Chylothorax--a rare complication after anterior and posterior spinal correction. Report on six cases. J Spine (Phila Pa 1976), 1986, 11(8):830-833.
21.	Oskouian RJ Jr, Johnson JP. Vascular complications in anterior thoracolumbar spinal reconstruction. J Neurosurg, 2002, 96(1 Suppl):1-5.
22.	Kaneda K, Taneichi H, Abumi K, et al. Anterior decompression and stabilization with the Kaneda device for thoracolumbar burst fractures associated with neurological deficits. J Bone Joint Surg Am, 1997, 79(1):69-83.
23.	Parthasarathy R, Sriram K, Santha T, et al. Short-course chemotherapy for tuberculosis of the spine. A comparison between ambulant treatment and radical surgery--ten-year report. J Bone Joint Surg Br, 1999, 81(3):464-471.
24.	Luk KD. Commentary:Instrumentation in the treatment of spinal tuberculosis, anterior or posterior? Spine J, 2011, 11(8):734-736.
25.	马远征, 胡明, 才晓军, 等. 脊柱结核外科治疗的探讨. 中华骨科杂志, 2005, 25(2):7-12.
26.	王自立, 金卫东, 乔永东, 等. 超短程化疗方案及病变椎体部分切除术治疗脊柱结核. 中华骨科杂志, 2005, 25(2):18-24.
27.	刘忠军, 党耕町, 陈仲强, 等. 胸腰椎三种前路内固定技术的应用. 中国脊柱脊髓杂志, 2000, 10(2):12-15.
28.	金大地, 陈建庭, 张浩, 等. 一期前路椎体间植骨并内固定治疗胸腰椎结核. 中华外科杂志, 2000, 38(12):21-23.
29.	施培华, 张剑, 范顺武, 等. 前路内固定矫正结核性脊柱畸形. 中华外科杂志, 2003, 41(4):55-58.
30.	王飞, 倪斌, 刘军, 等. 一期前路病灶清除钛网植骨内固定术治疗胸椎及胸腰段结核. 中国脊柱脊髓杂志, 2010, 51(5):390-394.
31.	王革, 赵毅, 张超, 等. 一期病灶清除植骨内固定术治疗脊柱结核83例体会. 山东医药, 2011, (13):17.
32.	韩国伟, 刘少喻, 梁春祥, 等. 前路减压植骨手术治疗胸腰椎结核伴截瘫39例. 中山大学学报(医学科学版), 2009, 30(S1):79-80, 92.
33.	贾长青, 付勤, 韩长旭, 等. 一期前路病灶清除植骨及内固定术治疗颈椎及颈胸段脊柱结核. 中国修复重建外科杂志, 2008, 22(9): 1149-1150.
34.	Rajasekaran S. Kyphotic deformity in spinal tuberculosis and its management. J Int Orthop, 2012, 36(2):359-365.

1. Ibrahim A, Lee KY, Kanoo LL, et al. Epidemiology of spinal cord injury in Hospital Kuala Lumpur. J Spine (Phila Pa1976), 2013, 38(5): 419-424.
2. 么鸿雁, 刘剑君. 遏制结核病策略(WHO 2005.9). 结核病健康教育, 2006, (1):35-43.
3. 张宏其, 田惠忠. 脊柱结核手术学. 广州:广东科技出版, 2014: 1728.
4. Furlan AD, Pennick V, Bombardier C, et al. 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. J Spine (Phila Pa 1976), 2009, 34(18):1929-1941.
5. Zeng X, Zhang Y, Kwong JS, et al. The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline:a systematic review. J Evid Based Med, 2015, 8(1):2-10.
6. 蔡希强, 董伟杰. 前路固定与后路固定治疗脊柱结核的矫形及神经康复效果研究. 中国当代医药, 2013, 20(14):11-13.
7. Garg B, Kandwal P, Nagaraja UB, et al. Anterior versus posterior procedure for surgical treatment of thoracolumbar tuberculosis:A retrospective analysis. J Indian J Orthop, 2012, 46(2):165-170.
8. Ma YZ, Cui X, Li HW, et al. Outcomes of anterior and posterior instrumentation under different surgical procedures for treating thoracic and lumbar spinal tuberculosis in adults. J Int Orthop, 2012, 36(2):299-305.
9. Pu X, Zhou Q, He Q, et al. A posterior versus anterior surgical approach in combination with debridement, interbody autografting and instrumentation for thoracic and lumbar tuberculosis. J Int Orthop, 2012, 36(2):307-313.
10. Zhang HQ, Li JS, Zhao SS, et al. Surgical management for thoracic spinal tuberculosis in the elderly:posterior only versus combined posterior and anterior approaches. J Arch Orthop Trauma Surg, 2012, 132(12):1717-1723.
11. Zhong W, Xiong G, Wang B, et al. Surgical management for thoracic spinal tuberculosis posterior only versus anterior video-assisted thoracoscopic surgery. PLoS One, 2015, 10(3):e119759.
12. 周树根, 陈少慧, 温干军, 等. 脊柱结核前后路不同术式的选择及疗效分析. 中国医药科学, 2014, 4(5):201-203.
13. 周焯家, 简月奎, 李波, 等. 腰骶椎结核治疗的方法选择(附65例分析). 中国矫形外科杂志, 2008, 16(15):1141-1143.
14. 崔旭, 马远征, 陈兴, 等. 脊柱结核前后路不同术式的选择及其疗效. 中国脊柱脊髓杂志, 2011, 21(10):807-812.
15. 崔旭, 马远征, 李宏伟, 等. 前路和后路内固定治疗胸腰椎结核的疗效比较. 中华医学杂志, 2012, 92(19):1325-1329.
16. 满益旺, 唐接福, 唐永太, 等. 前、后路内固定手术治疗胸腰段脊柱结核的对比研究. 中国当代医药, 2012, 19(3):42-43.
17. Jain AK, Dhammi IK, Prashad B, et al. Simultaneous anterior decompression and posterior instrumentation of the tuberculous spine using an anterolateral extrapleural approach. J Bone Joint Surg Br, 2008, 90(11):1477-1481.
18. Rajasekaran S, Shanmugasundaram TK. Prediction of the angle of gibbus deformity in tuberculosis of the spine. J Bone Joint Surg Am, 1987, 69(4):503-509.
19. Flynn JC, Hoque MA. Anterior fusion of the lumbar spine. Endresult study with long-term follow-up. J Bone Joint Surg Am, 1979, 61(8):1143-1150.
20. Nakai S, Zielke K. Chylothorax--a rare complication after anterior and posterior spinal correction. Report on six cases. J Spine (Phila Pa 1976), 1986, 11(8):830-833.
21. Oskouian RJ Jr, Johnson JP. Vascular complications in anterior thoracolumbar spinal reconstruction. J Neurosurg, 2002, 96(1 Suppl):1-5.
22. Kaneda K, Taneichi H, Abumi K, et al. Anterior decompression and stabilization with the Kaneda device for thoracolumbar burst fractures associated with neurological deficits. J Bone Joint Surg Am, 1997, 79(1):69-83.
23. Parthasarathy R, Sriram K, Santha T, et al. Short-course chemotherapy for tuberculosis of the spine. A comparison between ambulant treatment and radical surgery--ten-year report. J Bone Joint Surg Br, 1999, 81(3):464-471.
24. Luk KD. Commentary:Instrumentation in the treatment of spinal tuberculosis, anterior or posterior? Spine J, 2011, 11(8):734-736.
25. 马远征, 胡明, 才晓军, 等. 脊柱结核外科治疗的探讨. 中华骨科杂志, 2005, 25(2):7-12.
26. 王自立, 金卫东, 乔永东, 等. 超短程化疗方案及病变椎体部分切除术治疗脊柱结核. 中华骨科杂志, 2005, 25(2):18-24.
27. 刘忠军, 党耕町, 陈仲强, 等. 胸腰椎三种前路内固定技术的应用. 中国脊柱脊髓杂志, 2000, 10(2):12-15.
28. 金大地, 陈建庭, 张浩, 等. 一期前路椎体间植骨并内固定治疗胸腰椎结核. 中华外科杂志, 2000, 38(12):21-23.
29. 施培华, 张剑, 范顺武, 等. 前路内固定矫正结核性脊柱畸形. 中华外科杂志, 2003, 41(4):55-58.
30. 王飞, 倪斌, 刘军, 等. 一期前路病灶清除钛网植骨内固定术治疗胸椎及胸腰段结核. 中国脊柱脊髓杂志, 2010, 51(5):390-394.
31. 王革, 赵毅, 张超, 等. 一期病灶清除植骨内固定术治疗脊柱结核83例体会. 山东医药, 2011, (13):17.
32. 韩国伟, 刘少喻, 梁春祥, 等. 前路减压植骨手术治疗胸腰椎结核伴截瘫39例. 中山大学学报(医学科学版), 2009, 30(S1):79-80, 92.
33. 贾长青, 付勤, 韩长旭, 等. 一期前路病灶清除植骨及内固定术治疗颈椎及颈胸段脊柱结核. 中国修复重建外科杂志, 2008, 22(9): 1149-1150.
34. Rajasekaran S. Kyphotic deformity in spinal tuberculosis and its management. J Int Orthop, 2012, 36(2):359-365.

Chinese Journal of Evidence-Based Medicine

Anterior versus Posterior Approaches with One-Stage Debridement and Bone Grafting for Surgical Treatment of Spinal Tuberculosis: A Meta-Analysis

Abstract Full text Figures/Tables Video References Cited by

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