Abstract: Objective To evaluate the clinical efficacy of anterior versus posterior surgical approaches in the treatment of thoracic spinal tuberculous kyphosis.Methods From January 2018 to January 2023,a total of 67 patients with thoracic spinal tuberculous kyphosis were treated.According to the surgical approach,patients were divided into an anterior group(30 cases) and a posterior group(37 cases).The operation time, blood loss, Cobb Angle before the operation, 6 months after the operation, and at the last follow-up (12 months after the operation), visual analog scale (VAS) score, and oswestry disability index (ODI) were compared between the two groups.Results The anterior group had significantly longer operative time and greater intraoperative blood loss compared to the posterior group(P<0.05).At 6 months postoperatively,the Cobb angle in the anterior group was significantly lower than that in the posterior group(P<0.05).Subgroup analysis showed no significant differences between the anterior and posterior groups in preoperative,6 months,and 12 months Cobb angles,correction degree,correction loss for single-segment cases(P>0.05).However,in multi-segment cases,the anterior group had significantly higher Cobb angles at both preoperative and 6-month postoperative time points compared to the posterior group(P<0.05),while no significant differences were observed at 12 months,including in correction degree and loss(P>0.05).The VAS score and ODI of the anterior approach group and the posterior approach group at 6 months after surgery were lower than those before surgery, and the VAS score and ODI at 12 months after surgery were lower than those at 6 months after surgery. The differences were statistically significant (P<0.05). During the follow-up period, no recurrence of tuberculosis, failure of internal fixation or significant loss of correction was observed.Conclusion Both anterior and posterior surgical approaches can effectively treat single-segment tuberculous thoracic kyphosis,with comparable efficacy.The anterior approach is more suitable for patients with localized lesions requiring anterior decompression,whereas the posterior approach offers advantages in deformity correction and spinal stability reconstruction,especially in cases involving multi-segmental lesions.

Key words: thoracic spine;spinal tuberculosis;spinal kyphosis;kyphosis correction