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.	么鴻雁, 劉劍君. 遏制結核病策略(WHO 2005.9). 結核病健康教育, 2006, (1):35-43.
3.	張宏其, 田惠忠. 脊柱結核手術學. 廣州:廣東科技出版, 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.	蔡希強, 董偉杰. 前路固定與后路固定治療脊柱結核的矯形及神經康復效果研究. 中國當代醫藥, 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.	周樹根, 陳少慧, 溫干軍, 等. 脊柱結核前后路不同術式的選擇及療效分析. 中國醫藥科學, 2014, 4(5):201-203.
13.	周焯家, 簡月奎, 李波, 等. 腰骶椎結核治療的方法選擇(附65例分析). 中國矯形外科雜志, 2008, 16(15):1141-1143.
14.	崔旭, 馬遠征, 陳興, 等. 脊柱結核前后路不同術式的選擇及其療效. 中國脊柱脊髓雜志, 2011, 21(10):807-812.
15.	崔旭, 馬遠征, 李宏偉, 等. 前路和后路內固定治療胸腰椎結核的療效比較. 中華醫學雜志, 2012, 92(19):1325-1329.
16.	滿益旺, 唐接福, 唐永太, 等. 前、后路內固定手術治療胸腰段脊柱結核的對比研究. 中國當代醫藥, 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.	馬遠征, 胡明, 才曉軍, 等. 脊柱結核外科治療的探討. 中華骨科雜志, 2005, 25(2):7-12.
26.	王自立, 金衛東, 喬永東, 等. 超短程化療方案及病變椎體部分切除術治療脊柱結核. 中華骨科雜志, 2005, 25(2):18-24.
27.	劉忠軍, 黨耕町, 陳仲強, 等. 胸腰椎三種前路內固定技術的應用. 中國脊柱脊髓雜志, 2000, 10(2):12-15.
28.	金大地, 陳建庭, 張浩, 等. 一期前路椎體間植骨并內固定治療胸腰椎結核. 中華外科雜志, 2000, 38(12):21-23.
29.	施培華, 張劍, 范順武, 等. 前路內固定矯正結核性脊柱畸形. 中華外科雜志, 2003, 41(4):55-58.
30.	王飛, 倪斌, 劉軍, 等. 一期前路病灶清除鈦網植骨內固定術治療胸椎及胸腰段結核. 中國脊柱脊髓雜志, 2010, 51(5):390-394.
31.	王革, 趙毅, 張超, 等. 一期病灶清除植骨內固定術治療脊柱結核83例體會. 山東醫藥, 2011, (13):17.
32.	韓國偉, 劉少喻, 梁春祥, 等. 前路減壓植骨手術治療胸腰椎結核伴截癱39例. 中山大學學報(醫學科學版), 2009, 30(S1):79-80, 92.
33.	賈長青, 付勤, 韓長旭, 等. 一期前路病灶清除植骨及內固定術治療頸椎及頸胸段脊柱結核. 中國修復重建外科雜志, 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. 么鴻雁, 劉劍君. 遏制結核病策略(WHO 2005.9). 結核病健康教育, 2006, (1):35-43.
3. 張宏其, 田惠忠. 脊柱結核手術學. 廣州:廣東科技出版, 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. 蔡希強, 董偉杰. 前路固定與后路固定治療脊柱結核的矯形及神經康復效果研究. 中國當代醫藥, 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. 周樹根, 陳少慧, 溫干軍, 等. 脊柱結核前后路不同術式的選擇及療效分析. 中國醫藥科學, 2014, 4(5):201-203.
13. 周焯家, 簡月奎, 李波, 等. 腰骶椎結核治療的方法選擇(附65例分析). 中國矯形外科雜志, 2008, 16(15):1141-1143.
14. 崔旭, 馬遠征, 陳興, 等. 脊柱結核前后路不同術式的選擇及其療效. 中國脊柱脊髓雜志, 2011, 21(10):807-812.
15. 崔旭, 馬遠征, 李宏偉, 等. 前路和后路內固定治療胸腰椎結核的療效比較. 中華醫學雜志, 2012, 92(19):1325-1329.
16. 滿益旺, 唐接福, 唐永太, 等. 前、后路內固定手術治療胸腰段脊柱結核的對比研究. 中國當代醫藥, 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. 馬遠征, 胡明, 才曉軍, 等. 脊柱結核外科治療的探討. 中華骨科雜志, 2005, 25(2):7-12.
26. 王自立, 金衛東, 喬永東, 等. 超短程化療方案及病變椎體部分切除術治療脊柱結核. 中華骨科雜志, 2005, 25(2):18-24.
27. 劉忠軍, 黨耕町, 陳仲強, 等. 胸腰椎三種前路內固定技術的應用. 中國脊柱脊髓雜志, 2000, 10(2):12-15.
28. 金大地, 陳建庭, 張浩, 等. 一期前路椎體間植骨并內固定治療胸腰椎結核. 中華外科雜志, 2000, 38(12):21-23.
29. 施培華, 張劍, 范順武, 等. 前路內固定矯正結核性脊柱畸形. 中華外科雜志, 2003, 41(4):55-58.
30. 王飛, 倪斌, 劉軍, 等. 一期前路病灶清除鈦網植骨內固定術治療胸椎及胸腰段結核. 中國脊柱脊髓雜志, 2010, 51(5):390-394.
31. 王革, 趙毅, 張超, 等. 一期病灶清除植骨內固定術治療脊柱結核83例體會. 山東醫藥, 2011, (13):17.
32. 韓國偉, 劉少喻, 梁春祥, 等. 前路減壓植骨手術治療胸腰椎結核伴截癱39例. 中山大學學報(醫學科學版), 2009, 30(S1):79-80, 92.
33. 賈長青, 付勤, 韓長旭, 等. 一期前路病灶清除植骨及內固定術治療頸椎及頸胸段脊柱結核. 中國修復重建外科雜志, 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

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