comparison of outcomes in anterior, posterior, and combined surgical approaches for thoracic and lumbar spinal tuberculosis surgery: a multicenter study

Spinal tuberculosis (tb) is the most common form of skeletal tb, often causing deformity, neurological deficits, and instability. surgical intervention is essential in advanced cases, but the optimal approach—anterior, posterior, or combination—remains debated. to compare clinical, radiologic, and perioperative outcomes among anterior, posterior, and combination surgical approaches in thoracic and lumbar spinal tb. this multicenter cross-sectional study included 172 patients who underwent surgery for thoracic or lumbar spinal tb between 2020 and 2024 at three indonesian referral hospitals. patients were grouped by surgical approach: anterior (n=11), posterior (n=134), and combination (n=27). outcomes measured included visual analogue scale (vas), oswestry disability index (odi), frankel score, kyphotic angle correction, vertebral height restoration, fusion rate, operative time, blood loss, and complications. the posterior group showed the lowest mean postoperative vas (1.79 ± 0.77) and odi (18.97 ± 5.14). the combination approach provided the greatest kyphosis correction (20.55° ± 10.45°) and highest fusion rate (92.6%) but had the longest operative time (267.78 ± 87.02 minutes), the most blood loss (865.19 ± 408.94 ml), and the highest complication rate (22.2%). anterior surgery yielded comparable clinical outcomes but involved fewer patients. the posterior approach provides effective pain relief and functional improvement with fewer complications, while the combination approach achieves superior deformity correction and fusion at higher surgical risk. surgical decisions should be individualized based on clinical presentation and radiological severity.