Comparative Clinical Efficacy and Safety of Multi-Segment Thoracolumbar Tuberculosis Treated Through the Posterior "Detour Method" Versus the Combined Anterior-Posterior Approach: A Technique Note and Preliminary Retrospective Study.

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.