Anterior versus Posterior Approach in Surgical Treatment of Tuberculous Spondylodiscitis of Thoracic and Lumbar Spine

Abstract

ccording to the World Health Organization’s Global tuberculosis report 2015, tuberculosis ranked alongside HIV as a leading cause of death worldwide with 1.4 million deaths in 2014 [1]. Spinal tuberculosis is the most common encountered extra-pulmonary form of the disease and accounts for around 50% of musculoskeletal tuberculosis cases [2], Thoracic spine is the most commonly affected, and involvement of lumbar and lumbosacral region is less common [3, 4], spinal tuberculosis can cause severe neurological deficits, kyphotic deformities, and paraplegia. The effective anti-tubercular therapy has allowed disease cure in majority of patients with conservative management alone, however, surgery is indicated in patients having disabling back pain or progressive neurological deficit despite conservative management [5]. The aims of such treatment are to eradicate the tuberculosis lesion, relieve spinal nerve compression, regain spinal stability, and correct spinal deformity. Surgical treatment options are available including anterior spinal fusion, anterior-posterior spinal fusion, posterior spinal fusion alone, and posterior fusion followed by anterior spinal fusion [6–8]. Anterior debridement with interbody fusion and internal fixation is being widely used in the clinical setting for the treatment of spinal tuberculosis, particularly for spinal destruction in the anterior and middle columns [5].