BACKGROUND: There is a high prevalence of spinal tuberculosis in developing countries. Beside systematic chemotherapy, there are still some patients who need surgical treatment at certain phase of systematic treatment. However, there is no standard method for surgical treatment of spinal tuberculosis yet.
OBJECTIVE: To systematically evaluate the effect of anterior approach and posterior approach through consulting the literatures on the comparison between anterior approach and posterior approach for the treatment of spinal tuberculosis.
METHODS: The PubMed database, Medline database, Elseveir database, Wanfang database and CNKI database were searched with the key words of “thoracolumbar tuberculosis, controlled randomized trial, RCT, anterior, posterior” in Chinese and English. The randomized controlled trials on the comparison between anterior approach and posterior approach for the treatment of spinal tuberculosis were included. The operative time, intraoperative blood loss, correction degree of Cobb angle, loss of Cobb angle at final follow-up, allograft fusion time, total hospital stay and the excellent and good rate of the effectiveness were compared by Revman5.1 software.
RESULTS AND CONCLUSION: A total of 1 438 articles were screened out, and finally 9 randomized controlled trials were included. The total number of patients was 692, in which 324 were treated with anterior approach and 368 were treated with posterior approach. The operative time of anterior approach of 46.25(40.23, 52.26) minutes was less than that of posterior approach; the intraoperative blood loss of anterior approach of 148.91(135.12, 1 625.70) mL less than that of posterior approach; the correct degree of Cobb angle of anterior approach of 2.40°(2.21°, 4.62°) was smaller than that of posterior approach; the loss of Cobb angle of anterior approach of 0.66°(0.41°, 0.91°) was larger than that of posterior approach; the total hospital stay of anterior approach of 0.34 (-0.32,1.01) days was less than that of posterior approach; the allograft fusion time of anterior approach was less than that of posterior approach for 0.26 (0.18, 0.34) months; the number of cases with excellent and good effect of anterior approach was more than that of posterior approach for 1.18(-0.48, 2.85); there were significant differences in operative time, intraoperative blood loss, correct degree of Cobb angle, loss of Cobb angle at final follow-up and allograft fusion time between anterior and posterior approaches (P < 0.01). The results showed that there were significant differences in operative time, intraoperative blood loss, correct degree of Cobb angle, loss of Cobb angle at final follow-up and allograft fusion time between anterior and posterior approaches for the treatment of spinal tuberculosis, but there were no significant differences in total hospital stay and surgical efficacy.