Surgical approach in lumbar spine tuberculosis, which is best? A meta-analysis

Link of Video Abstract: https://youtu.be/ZORIuJI9O2I Introduction: Lumbar spine is the area with the maximum spinal load, great shearing force and the stress concentration points with high range of motion. Proper surgical approach in lumbar spinal TB will not only affect the biomechanical outcome but also the surgical outcome. Therefore, this study aims to analyze which of the two most commonly used approach, posterior or combined approach, is best for lumbar spinal TB Methods: Studies comparing surgical approach of lumbar or lumbosacral spinal tuberculosis by single posterior approach versus combined anterior and posterior approach were identified in a literature search conducted from study inception to February 2023. Visual analog score (VAS), Cobb angle, Lordotic angle, Japanese Orthopedic Association (JOA) score, Erithrocyte Sedimentation Rate (ESR), surgical time, intraoperative bleeding, complication, and time of bone graft fusion was analyzed. Results: In total, 855 studies were found from the search engines. From screening, 10 studies were finally included for the final quantitative analysis. No difference in VAS (p=0.87) and cobb angle difference (p=0.65) were found from the two studies. Better outcome for combined approach was found in terms of ESR decreasing (p=0.02), and time of bone graft fusion (p=0.09). Meanwhile, better outcome for posterior approach was found on lordotic angle (p=0.02), surgical time (p<0.05), intraoperative bleeding (p<0.05), and complication rate. Conclusion: This meta-analysis found that posterior approach on one or two level of lumbar spinal TB enables better lordotic correction angle, surgical time, intraoperative bleeding, and complication incidence compared to combined approach.