To assess clinical outcomes of surgical management of adults with thoracic and lumbar tuberculosis in Tibet by comparing posterior only, anterior only, and combined posterior and anterior surgical approaches.

The medical records for 62 patients treated for thoracic and lumbar tuberculosis between January 2010 and September 2018 were retrospectively reviewed. Among them, 28 patients were treated with single-stage anterior debridement and interbody fusion with instrumentation (Group A), 11 patients with posterior instrumentation, anterior debridement, and bone graft in a single or two-stage procedure (Group B), and 23 patients with posterior debridement and strut grafting with instrumentation (Group C). Operative time, blood loss, Visual Analog Scale score (VAS), complications, recovery of neurological function, Cobb angle, correction rate, and loss angle were compared among all groups.

The patients were followed for 5-96 months, with an average of (10±5) months. The operative time of Group C [(213.5±42.3) min] was significantly shorter than that of Groups A [(260.9±58.1) min] and B [(292.7±45.2) min] (P<0.05). The blood loss in Group C [(802.2±218.6) ml] was significantly less than that in Group B [(981.8±221.7) ml, P<0.05], although there was no statistically significant difference between Groups A and C (P>0.05). There was no statistically significant between groups in length of stay (P>0.05). The correction rate was superior in Groups B [(73.4±11.2)%] and C [(72.5±13.4)%] compared with Group A [(45.2±16.8)%], whereas the VAS score showed no statistically significant difference among the groups (P>0.05). Two patients developed recurrence 4 and 7 months after operation, one in Group A and one in Group B. During the operation, there were five cases of pleura rupture leading to hemopneumothorax (3 in Group A and 2 in Group B) and two cases of peritoneum rupture in Group B.

For patients with thoracic and lumbar tuberculosis, the use of single-stage anterior debridement and interbody fusion with instrumentation approach is limited for the unsatisfactory corrective effect and high complications. Although the combined approach produces satisfactory outcomes, it remains more traumatic and is associated with longer operative time and more blood loss. Therefore, the posterior approach is recommended, not only because it achieves good results, but also because it has reduced complications, shorter operative time, and less blood loss.