ArticleFrontiers in medicine2026
Clinical outcomes of individualized surgical pathways in elderly patients with spinal tuberculosis: a retrospective cohort study in eastern China.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: Although surgical indications for adult spinal tuberculosis (TB) are well established, optimal surgical strategies for elderly patients remain uncertain. This study described the clinical outcomes of an individualized staged management pathway for elderly patients with spinal TB in eastern China and reported outcomes of a clinically distinct cohort undergoing combined posterior and anterior surgery. No comparative efficacy hypothesis was tested. Methods: This retrospective observational cohort study included patients treated between January 2020 and December 2022. Forty-two patients were classified according to treatment pathway. Group A comprised 23 patients managed with ultrasound-guided abscess drainage followed by posterior stabilization and posterolateral fusion, with anterior surgery reserved for inadequate infection control. Group B comprised 19 patients who underwent combined posterior and anterior surgery because immediate anterior debridement and/or interbody reconstruction were required. Because pathway selection was indication-based and the cohorts had different operative indications, outcomes were summarized descriptively rather than compared statistically. Index spinal operative time, index estimated blood loss, visual analog scale score, Oswestry Disability Index, kyphotic angle, Frankel grade, postoperative complications, and secondary surgery were recorded. Results: All patients achieved satisfactory clinical and radiographic outcomes during 24-45 months of follow-up. Mean index operative time was 211.26 ± 70.30 min in Group A and 315.68 ± 70.92 min in Group B, and mean index estimated blood loss was 406.52 ± 224.26 mL and 594.74 ± 139.33 mL, respectively. These values described different clinically selected index operations and were not statistically compared. At final follow-up, Frankel grade E was recorded in 19/23 (82.6%) patients in Group A and 16/19 (84.2%) in Group B, compared with 15/23 (65.2%) and 12/19 (63.2%) preoperatively. Recurrence occurred in one patient in Group A and three patients in Group B. Conclusions: The individualized staged pathway was completed without salvage anterior surgery in 22 of 23 Group A patients, while one patient required subsequent anterior debridement and interbody fusion. These descriptive data support feasibility in selected patients but do not establish that preoperative catheter drainage is necessary or superior to posterior surgery without drainage. Combined posterior-and-anterior surgery remained appropriate when immediate anterior debridement or reconstruction was indicated.
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