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Anterior versus posterior instrumentation for treatment of thoracolumbar tuberculosis

A meta-analysis

Anteriore vs. posteriore Instrumentierung zur Therapie der thorakolumbalen Tuberkulose

Eine Metaanalyse

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Abstract

Background

To compare clinical and functional outcomes of anterior versus posterior debridement and spinal fixation for surgical treatment of thoracolumbar tuberculosis.

Methods

A computer-based online search of the Cochrane Library, PubMed, EMBase, Wanfang, VIP, and the CNKI database was performed. The methodological quality of included studies was evaluated, and data analyses were performed using RevMan 5.0 software (The Nordic Cochrane Centre, The Cochrane Collaboration Copenhagen, Denmark).

Results

Eleven trials were studied, with eight performed in China, two in Egypt, and one in India. The results showed significant differences between the two operative approaches in terms of correction of kyphotic angle and intraoperative blood loss, but not in terms of operation time, hospital stay, fusion time, and loss of correction at the final follow-up.

Conclusion

The anterior and posterior approaches are equally good methods for treatment of thoracolumbar tuberculosis. The anterior approach results in less blood loss, whereas posterior instrumentation is better suited for correction of kyphotic angle.

Zusammenfassung

Hintergrund

Ziel war der Vergleich klinischer und funktioneller Ergebnisse des anterioren gegenüber dem posterioren Débridement und der spinalen Fixation als chirurgische Behandlung der thorakolumbalen Tuberkulose.

Methoden

Eine computerbasierte Onlinerecherche in den Datenbanken Cochrane Library, PubMed, EMBase, Wanfang, VIP und CNKI wurde durchgeführt. Die methodologische Qualität der einbezogenen Studien wurde bewertet und Datenanalysen unter Verwendung der Software RevMan 5.0 (The Nordic Cochrane Centre, The Cochrane Collaboration, Kopenhagen, Dänemark) ausgeführt.

Ergebnisse

Es wurden 11 Studien untersucht, 8 davon waren in China, 2 in Ägypten und eine in Indien durchgeführt worden. Die Ergebnisse wiesen signifikante Unterschiede zwischen den beiden operativen Ansätzen in Bezug auf die Korrektur des Kyphosewinkels und den intraoperativen Blutverlust auf, nicht jedoch in Bezug auf die Operationsdauer, die Krankenhausverweildauer, die Dauer bis zur Fusion und einen Verlust der Korrektur bei der abschließenden Nachuntersuchung.

Schlussfolgerung

Der anteriore und posteriore Ansatz sind gleich gute Verfahren zur Therapie der thorakolumbalen Tuberkulose. Bei dem anterioren Ansatz kommt es zu einem geringeren Blutverlust, während die posteriore Instrumentierung sich besser zur Korrektur des Kyphosewinkels eignet.

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Abbreviations

CI:

Confidence intervals

RR:

Relative risk

SMD:

Standard mean difference

TB:

Tuberculosis

WMD:

Weighted mean difference

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Authors and Affiliations

  1. Department of Orthopedics, Second Hospital of Lanzhou University, 730000, Lanzhou, Gansu Province, China

    Kai Wang, Yuliang Wang, Yayi Xia & Jingsheng Liu

  2. Department of Oncology, Second Hospital of Lanzhou University, 730000, Lanzhou, Gansu Province, China

    Na Wang & Feixue Song

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  1. Kai Wang
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Corresponding author

Correspondence to Jingsheng Liu.

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Conflict of interest

K. Wang, N. Wang, Y. Wang, Y. Xia, F. Song, and J. Liu declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors. Institutional review board approval and patient consent were not required for this meta-analysis of observational studies.

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Wang, K., Wang, N., Wang, Y. et al. Anterior versus posterior instrumentation for treatment of thoracolumbar tuberculosis. Orthopäde 48, 207–212 (2019). https://doi.org/10.1007/s00132-018-03662-w

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  • DOI: https://doi.org/10.1007/s00132-018-03662-w

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