Posterior approach versus anterior-posterior approach in the treatment of lumbar Brucellar spondylitis: a Meta-analysis
10.3760/cma.j.cn231583-20240709-00194
- VernacularTitle:后入路与前后联合入路手术治疗腰椎布鲁氏菌病性脊柱炎的Meta分析
- Author:
Xingguo TAN
1
;
Feng LI
;
Tao ZHANG
;
Xiaohong TIAN
;
Songkai LI
Author Information
1. 甘肃中医药大学第一临床医学院，兰州 730030
- Publication Type:Journal Article
- Keywords:
Lumbar vertebrae;
Brucellar spondylitis;
One-stage debridement;
Intervertebral bone graft fusion;
Surgery
- From:
Chinese Journal of Endemiology
2025;44(4):337-344
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the efficacy of two surgical approaches for lumbar Brucellar spondylitis: one-stage posterior approach debridement with intervertebral bone graft fusion and pedicle screw-rod internal fixation (simple posterior group) versus one-stage anterior approach debridement with intervertebral bone graft fusion combined with posterior pedicle screw-rod internal fixation (combined anterior-posterior group).Methods:A systematic search was performed in the Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), VIP, and Wanfang Data from the time of database establishment to May 2024 to identify randomized controlled trial (RCT) and controlled clinical trial (CCT) comparing the two surgical approaches (simple posterior group and combined anterior-posterior group) in the treatment of lumbar Brucellar spondylitis. Meta-analysis was conducted by two researchers using RevMan 5.4.0 and Stata 13.1 software.Results:A total of 8 studies (2 RCTs, 6 CCTs studies) were included, including 669 patients (344 in the simple posterior group and 325 in the combined anterior-posterior group). Meta-analysis results revealed that the simple posterior group demonstrated shorter surgical time [ WMD = - 125.68, 95% CI ( - 186.84, - 64.53), P < 0.001], less intraoperative bleeding [ WMD = - 385.76, 95% CI ( - 572.40, - 199.11), P < 0.001], shorter hospital stay [ WMD = - 5.60, 95% CI ( - 8.30, - 2.91), P < 0.001], earlier postoperative ambulation time [ WMD = - 6.15, 95% CI ( - 10.72, - 1.59), P = 0.008], and a smaller Cobb angle at 3 months after surgery [ WMD = - 0.66, 95% CI ( - 1.23, - 0.09), P = 0.020]. However, there was no statistically significant differences in erythrocyte sedimentation rate [ WMD = 0.01, 95% CI ( - 0.90, 0.93), P = 0.980], visual analogue scale scores [ WMD = - 0.19, 95% CI ( - 0.40, 0.01), P = 0.070], Oswestry disability index score [ WMD = 0.02, 95% CI ( - 0.61, 0.66), P = 0.950] at 3 months after surgery, and postoperative complication rate [ OR = 0.57, 95% CI (0.17, 1.94), P = 0.370]. Conclusions:Compared with the combined anterior-posterior approach, the simple posterior approach has the advantages of shorter surgical time, less bleeding, and faster postoperative recovery. However, there is no significant difference between the two in terms of symptom improvement, functional recovery, and incidence of complications. Simple posterior approach surgery is an effective choice for treating lumbar Brucellar spondylitis.
