Clinical Efficacy of Posterior and Combined Posterior-Anterior Surgical Approaches for Intractable Tuberculous Thoracolumbar Kyphosis: A Retrospective Analysis

Study design A retrospective, single-center study. Objective To evaluate the effectiveness of posterior and combined posterior-anterior surgical approaches for treating intractable tuberculous thoracolumbar kyphosis. Summary of background data Intractable spinal tuberculosis, though rare, poses significant therapeutic challenges. Its management is complex and remains a subject of debate. Methods We analyzed 63 cases of intractable tuberculous thoracolumbar kyphosis retrospectively. The evaluation criteria included clinical symptoms, kyphotic angle correction rate, sagittal vertebral axis (SVA), operative time, intraoperative bleeding, and surgical complications. Functional assessments were conducted using the American Spinal Injury Association (ASIA) spinal cord injury classification, the visual analog scale (VAS), the Oswestry Disability Index (ODI), and the Kirkaldy-Willis functional score. Fusion success was determined by the Eck fusion grading scale. Results All patients with bone grafting achieved grade I fusion. The preoperative kyphotic angles were 59.4±12.6 degrees and 102.9±16.6 degrees, and the improved postoperative kyphotic angles were 19.9±6.2 degrees and 28.5±9.6 degrees, with correction rates of 65.5%±12.0% and 72.0%±9.5%, respectively. The preoperative SVA were 27.6±10.7 and 39.1±18.6 mm, which postoperatively improved to 20.6±9.0 and 26.4±12.1 mm. The Kirkaldy-Willis functional scores were 89.7% and 85.3%. No tuberculosis recurrence, internal fixation loosening, and obvious loss of correction were found during the follow-up period. Conclusions Posterior surgery is effective for mild cases, while combined posterior-anterior surgery is necessary for severe cases, offering a safe and reliable treatment approach.