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Updated: Jun 12, 2025
A Retrospective Study on Endoscopic Surgery for the Treatment of Paravertebral Abscess in Spinal Tuberculosis Patients
Published on: October 25, 2024
Comparison of two surgical approaches in treating children with thoracolumbar junction tuberculosis: a multicenter
Jingyu Wang1, Xueying Zhang2, Xiaobin Wang3
1Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China.
Insights
The posterior-only surgical approach for pediatric Thoracolumbar Junction Tuberculosis (TLJ TB) is safer and more effective than the posterior-anterior approach. It reduces surgical time, complications, and promotes faster recovery in children aged 3-10 years.
Area of Science:
- Pediatric Orthopedics
- Spinal Surgery
- Infectious Diseases
Background:
- Thoracolumbar Junction (TLJ) Tuberculosis (TB) in children requires effective surgical intervention.
- Comparing surgical approaches is crucial for optimizing pediatric spinal TB treatment outcomes.
Purpose of the Study:
- To compare the clinical outcomes and complications of posterior-anterior versus posterior-only surgical approaches for pediatric TLJ TB.
- To evaluate the efficacy and safety of different surgical techniques in children aged 3-10 years.
Main Methods:
- A multicenter retrospective analysis of 52 pediatric TLJ TB patients (3-10 years old).
- Patients underwent debridement, fusion, and instrumentation via posterior-anterior (n=24) or posterior-only (n=28) approaches.
- Outcomes assessed included surgical time, blood loss, complications, inflammatory markers, pain, disability, kyphosis, and neurological function.
Main Results:
- The posterior-only group showed significantly shorter surgical time, less blood loss, and reduced hospitalization duration compared to the posterior-anterior group.
- Both groups demonstrated significant improvement in pain, disability, neurological function, and kyphosis post-surgery.
- No significant differences were observed between groups regarding inflammatory markers, functional recovery, or long-term outcomes like fusion or TB recurrence.
Conclusions:
- Both surgical approaches effectively treat pediatric TLJ TB, decompress the spinal cord, and restore stability.
- The posterior-only approach offers advantages in reduced surgical time, trauma, complications, and faster recovery.
- The posterior-only approach is recommended as a safer, minimally invasive option for pediatric TLJ TB involving up to two segments.
Objectives:
We conducted a multicenter retrospective analysis to compare the clinical outcomes and complications associated with the posterior-anterior and posterior-only approaches in treating Thoracolumbar Junction (TLJ) Tuberculosis (TB) in children aged 3-10 years.
Methods:
Herein, 52 TLJ TB patients (age range = 3-10 years; mean age = 6.8 ± 2.2 years; females = 22; males = 30) treated with debridement, fusion, and instrumentation were recruited from two hospitals in China between May 2008 and February 2022, and their clinical data were reviewed retrospectively. Among them, 24 group A patients and 28 group B patients underwent the posterior-anterior and posterior-only approaches, respectively. The two groups were assessed for surgical time, blood loss, hospitalization duration, operative complications, inflammatory indicators, Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, kyphosis angles, and neurologic functions. Results or differences with P < 0.05 were considered statistically significant.
Results:
The average follow-up period was 37.5 ± 23.3 months. Compared to group A patients, group B patients exhibited significantly lower surgical time, blood loss amount, time it took to stand, and hospitalization duration, as well as fewer complications. Notably, the Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) values of patients in both groups returned to normal one year post-surgery. Furthermore, compared to the preoperative values, patients' VAS and ODI scores, as well as neurological functions and kyphosis angles, were significantly improved postoperatively and at the final follow-up, but with no statistically significant differences between the two groups. Moreover, there was no internal fixation failure or TB recurrence, and all patients exhibited solid bone fusion at the last follow-up.
Conclusion:
For pediatric TLJ TB involving no or at most two segments, both posterior-anterior and posterior-only approaches could effectively remove lesions and decompress the spinal cord, restore spinal stability, correct kyphosis, and prevent deformity deterioration. Nonetheless, the posterior-only approach can more effectively shorten the surgical time, reduce related trauma and complications, and promote rapid recovery, making it a safer and highly preferable minimally invasive approach.
