Objective: With the progress of spinal tuberculosis treatment theory and surgical tools, how to further improve the surgical efficacy, reduce surgical trauma, and increase safety in multi-segmental spinal tuberculosis is still controversial. Through the improvement of traditional posterior surgery, we explored the posterior Detour method to preserve bilateral lamina in the treatment of multi-segment thoracolumbar tuberculosis and followed up on its clinical efficacy and imaging results to observe its clinical value and further evaluate its effectiveness and safety.
Methods: Between January 2022 and December 2024, 32 patients suffering from multi-segment thoracolumbar tuberculosis underwent the combined anterior and posterior approach, or the “detour” method, and were divided into the Anterior–Posterior group (AP, 15 patients) and the Detour group (17 patients). Demographic characteristics, surgical details, and radiological outcomes were collected for analysis.
Results: Thirty-two patients were included in the study, including 15 patients treated with the AP technique and 17 patients treated with the Detour method. Significant differences were found in surgery time, total postoperative drainage volume, and time to first out-of-bed activity. The two groups were similar in sex, BMI, smoking and drinking history, corrected Cobb angle, VAS, CRP, and ODI.
Conclusions: Compared with combined anterior and posterior procedures, the “Detour method” enables a 180° decompression of the spinal cord and 270° reconstruction scope within a smaller incision, providing a safe and effective method for the treatment of multi-segmental spinal tuberculosis.
| [1] |
K. Chinpong, K. Thavornwattana, P. Armatrmontree, et al., “Spatiotemporal Epidemiology of Tuberculosis in Thailand From 2011 to 2020,” Biology-Basel 11, no. 5 (2022): 755.
|
| [2] |
J. Fan, T. Lan, K. Tang, et al., “The Comparative Influence of 2 and 4 Weeks Preoperative Antituberculosis Treatment on Spinal Tuberculosis Surgery: A Multicenter, Prospective, Randomized Clinical Trial,” Infectious Diseases and Therapy 10, no. 3 (2021): 1451–1463.
|
| [3] |
R. N. Dunn and M. Ben Husien, “Spinal Tuberculosis: Review of Current Management,” Bone & Joint Journal 100-B, no. 4 (2018): 425–431.
|
| [4] |
K. Khanna and S. Sabharwal, “Spinal Tuberculosis: A Comprehensive Review for the Modern Spine Surgeon,” Spine Journal 19, no. 11 (2019): 1858–1870.
|
| [5] |
S. Ruparel, M. Tanaka, R. Mehta, et al., “Surgical Management of Spinal Tuberculosis-The Past, Present, and Future,” Diagnostics 12, no. 6 (2022): 1307.
|
| [6] |
J. Shen, Q. Zheng, Y. Wang, and X. Ying, “One-Stage Combined Anterior-Posterior Surgery for Thoracic and Lumbar Spinal Tuberculosis,” Journal of Spinal Cord Medicine 44, no. 1 (2021): 54–61.
|
| [7] |
Y. Zhong, K. Yang, Y. Ye, W. Huang, W. Liu, and J. Luo, “Single Posterior Approach Versus Combined Anterior and Posterior Approach in the Treatment of Spinal Tuberculosis: A Meta-Analysis,” World Neurosurgery 147 (2021): 115–124.
|
| [8] |
Z. Zhang, B. W. Hu, L. N. Wang, et al., “Comparison of Long-Term Clinical and Radiographical Outcomes Between the Anterior and Combined Anterior and Posterior Approaches for Treating Lumbosacral Tuberculosis,” Orthopaedic Surgery 15, no. 4 (2023): 973–982.
|
| [9] |
U. Talu, A. Gogus, C. Ozturk, A. Hamzaoglu, and U. Domanic, “The Role of Posterior Instrumentation and Fusion After Anterior Radical Deb Ridement and Fusion in the Surgical Treatment of Spinal Tuberculosis: Experience of 127 Cases,” Clinical Spine Surgery 19, no. 8 (2006): 554–559, https://doi.org/10.1097/01.bsd.0000211202.93125.c7.
|
| [10] |
X. Wang, X. Pang, P. Wu, C. Luo, and X. Shen, “One-Stage Anterior Debridement, Bone Grafting and Posterior Instrumentation vs. Single Posterior Debridement, Bone Grafting, and Instrumentation for the Treatment of Thoracic and Lumbar Spinal Tuberculosis,” European Spine Journal 23, no. 4 (2014): 830–837.
|
| [11] |
B. Anderson and B. Shahidi, “The Impact of Spine Pathology on Posterior Ligamentous Complex Structure and Function,” Current Reviews in Musculoskeletal Medicine 16, no. 12 (2023): 616–626.
|
| [12] |
Y. Wang, S. Xiao, G. Zeng, H. Zhang, E. Alonge, and Z. Yang, “Comparison of Clinical Outcomes of Posterior-Only Transforaminal Debridement and Interbody Fusion With Preservation of Posterior Ligamentous Complex Versus Conventional Posterior-Only Debridement and Interbody Fusion for Thoracic Spine Tuberculosis: A Prospective, Randomized, Controlled, Clinical Trial–A Pilot Study,” Neurospine 21, no. 3 (2024): 954–965.
|
| [13] |
G. Yadav, P. Kandwal, and S. S. Arora, “Short-Term Outcome of Lamina-Sparing Decompression in Thoracolumbar Spinal Tuberculosis,” Journal of Neurosurgery. Spine 33, no. 5 (2020): 627–634.
|
| [14] |
K. H. Bridwell, L. G. Lenke, K. W. McEnery, C. Baldus, and K. Blanke, “Anterior Fresh Frozen Structural Allografts in the Thoracic and Lumbar Spine. Do They Work if Combined With Posterior Fusion and Instrumentation in Adult Patients With Kyphosis or Anterior Column Defects?,” Spine 20, no. 12 (1995): 1410–1418.
|
| [15] |
R. K. Garg and D. S. Somvanshi, “Spinal Tuberculosis: A Review,” Journal of Spinal Cord Medicine 34, no. 5 (2011): 440–454.
|
| [16] |
S. Na, Z. Lyu, and S. Zhang, “Diagnosis and Treatment of Skipped Multifocal Spinal Tuberculosis Lesions,” Orthopaedic Surgery 15, no. 6 (2023): 1454–1467.
|
| [17] |
A. Muheremu, X. Niu, Z. Wu, and W. Tian, “Study on Anterior and Posterior Approaches for Spinal Tuberculosis: A Meta-Analysis,” European Journal of Orthopaedic Surgery & Traumatology 25, no. 1 (2015): S69–S76.
|
| [18] |
C. Yilmaz, H. Y. Selek, I. Gürkan, B. Erdemli, and Z. Korkusuz, “Anterior Instrumentation for the Treatment of Spinal Tuberculosis,” Journal of Bone and Joint Surgery. American Volume 81, no. 9 (1999): 1261–1267.
|
| [19] |
S. Xu, G. Wang, J. Yang, S. Zhang, Y. Song, and Q. Wang, “Anterior Debridement, Bone Grafting and Fixation for Cervical Spine Tuberculosis: An Iliac Bone Graft Versus a Structural Manubrium Graft,” BMC Musculoskeletal Disorders 23, no. 1 (2022): 236.
|
| [20] |
W. Wu, Z. Li, R. Lin, H. Zhang, and J. Lin, “Anterior Debridement, Decompression, Fusion and Instrumentation for Lower Cervical Spine Tuberculosis,” Journal of Orthopaedic Science 25, no. 3 (2020): 400–404.
|
| [21] |
S. Sural, S. Sehrawat, A. Kashyap, A. S. Bali, and A. Khanna, “Anterolateral Versus Transpedicular Decompression With Posterior Instrumentation: A Randomized Prospective Study in Paradiscal Thoracic Spine Tuberculosis,” Spine Surgery and Related Research 9 (2025): 638–646, https://doi.org/10.22603/ssrr.2025-0057.
|
| [22] |
Z. Lui, J. Liu, A. Peng, X. Long, D. Yang, and S. Huang, “One-Stage Posterior Debridement and Transpedicular Screw Fixation for Treating Monosegmental Thoracic and Lumbar Spinal Tuberculosis in Adults,” TheScientificWorldJOURNAL 2014 (2014): 137106, https://doi.org/10.1155/2014/137106.
|
| [23] |
N. K. Karn, R. Jha, P. Sitoula, M. Singh, and A. K. Jain, “Comparison of Extrapleural Anterolateral Decompression and Transthoracic Anterior Decompression for Tuberculosis of the Dorsal Spine,” Jr Nobel Medical College 3, no. 1 (2014): 46–51, https://doi.org/10.3126/jonmc.v3i1.12237.
|
| [24] |
A. K. Jain, A. Agrawal, I. K. Dhami, P. K. Agrawal, and S. Singh, “Extrapleural Anterolateral Decompression in Tuberculosis of the Dorsal Spine,” Journal of Bone and Joint Surgery 86-B (2004): 1027–1031, https://doi.org/10.1302/0301-620X.86B7.14546.
|
| [25] |
A. K. Jain, I. K. Dhammi, B. Prashad, S. Sinha, and P. Mishra, “Simultaneous Anterior Decompression and Posterior Instrumentation of the Tuberculous Spine Using an Anterolateral Extrapleural Approach,” Journal of Bone and Joint Surgery 90-B (2008): 1477–1481, https://doi.org/10.1302/0301-620X.90B11.20972.
|
| [26] |
A. K. Jain, I. K. Dhammi, S. Jain, and J. Kumar, “Simultaneously Anterior Decompression and Posterior Instrumentation by Extrapleural Retroperitoneal Approach in Thoracolumbar Lesions,” Indian Journal of Orthopaedics 44, no. 4 (2010): 409–416, https://doi.org/10.4103/0019-5413.69315.
|
| [27] |
A. R. D'souza, B. Mohapatra, M. L. Bansal, and K. Das, “Role of Posterior Stabilization and Transpedicular Decompression in the Treatment of Thoracic and Thoracolumbar TB A Retrospective Evaluation,” Clinical Spine Surgery 30, no. 10 (2017): E1426–E1433, https://doi.org/10.1097/BSD.0000000000000498.
|
| [28] |
A. Jain, R. K. Jain, and V. Kiyawat, “Evaluation of Outcome of Transpedicular Decompression and Instrumented Fusion in Thoracic and Thoracolumbar Tuberculosis,” Asian Spine Journal 11, no. 1 (2017): 32–35, https://doi.org/10.4184/asj.2017.11.1.31.
|
| [29] |
H. Zhang, B. Sheng, M. Tang, et al., “One-Stage Surgical Treatment for Upper Thoracic Spinal Tuberculosis by Internal Fixation, Debridement, and Combined Interbody and Posterior Fusion via Posterior-Only Approach,” European Spine Journal 22, no. 3 (2013): 616–623.
|
| [30] |
G. Lü, B. Wang, J. Li, W. Liu, and I. Cheng, “Anterior Debridement and Reconstruction via Thoracoscopy-Assisted Mini-Open Approach for the Treatment of Thoracic Spinal Tuberculosis: Minimum 5-Year Follow-Up,” European Spine Journal 21, no. 3 (2012): 463–469.
|
| [31] |
Y. Huang, J. Lin, X. Chen, J. Lin, Y. Lin, and H. Zhang, “A Posterior Versus Anterior Debridement in Combination With Bone Graft and Internal Fixation for Lumbar and Thoracic Tuberculosis,” Journal of Orthopaedic Surgery and Research 12, no. 1 (2017): 150.
|
| [32] |
Y. C. Chiu, S. C. Yang, Y. H. Kao, and Y. K. Tu, “Single Posterior Approach for Circumferential Debridement and Anterior Reconstruction Using Fibular Allograft in Patients With Skipped Multifocal Spinal Tuberculosis,” Journal of Orthopaedic Surgery and Research 17, no. 1 (2022): 489.
|
| [33] |
H. Jiang, Z. M. Xiao, X. L. Zhan, and M. L. He, “Anterior Transsternal Approach for Treatment of Upper Thoracic Vertebral Tuberculosis,” Orthopaedic Surgery 2, no. 4 (2010): 305–309.
|
| [34] |
A. J. Bizdikian and R. El Rachkidi, “Posterior Ligamentous Complex Injuries of the Thoracolumbar Spine: Importance and Surgical Implications,” Cureus 13, no. 10 (2021): e18774.
|
| [35] |
O. Nakai, A. Ookawa, and I. Yamaura, “Long-Term Roentgenographic and Functional Changes in Patients Who Were Treated With Wide Fenestration for Central Lumbar Stenosis,” Journal of Bone and Joint Surgery. American Volume 73, no. 8 (1991): 1184–1191.
|
| [36] |
L. Jiang, X. Sheng, Z. Deng, Q. Gao, and S. Liu, “A Comparative Study of One-Stage Posterior Unilateral Limited Laminectomy vs. Bilateral Laminectomy Debridement and Bone Grafting Fusion Combined With Internal Fixation for the Treatment of Aged Patients With Single-Segment Spinal Tuberculosis,” BMC Musculoskeletal Disorders 23, no. 1 (2022): 619.
|
| [37] |
J. Li, S. Huang, Y. Tang, X. Wang, and T. Pan, “Biomechanical Analysis of the Posterior Bony Column of the Lumbar Spine,” Journal of Orthopaedic Surgery and Research 12, no. 1 (2017): 132.
|
| [38] |
M. Li, J. Huang, J. Chen, et al., “Unilateral Limited Laminectomy for Debridement to Treat Localized Short-Segment Lumbosacral Spinal Tuberculosis: A Retrospective Case Series,” Orthopaedic Surgery 13, no. 4 (2021): 1170–1180.
|
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