Comparison of clinical outcomes between the anterior-only approach and two-staged combined Anterior-Posterior approaches for cervical pyogenic spondylitis.

Abstract

To compare the clinical outcomes between anterior-only approach and two-staged combined anterior-posterior approaches (CAPA) for Cervical pyogenic spondylitis (CPS). A retrospective analysis was conducted on 60 CPS patients (37 males, 23 females; mean age 55.2 ± 10.5 years) treated between 2018 and 2023. The patients were divided into the anterior-only approach group (A) and the two-staged CAPA group (B). Outcomes were assessed on admission and at postoperative intervals, including Visual Analogue Scale (VAS), Japanese Orthopaedic Association (JOA) scores, Frankel grading, inflammatory markers (WBC, ESR, CRP), and radiologic parameters (C2-C7 global Cobb angle, segment Cobb angle of the lesion, fusion status). Statistical analysis was used repeated-measures ANOVA via SPSS 26.0. Significant improvements were observed in pain relief, neurological function, and inflammatory markers after surgery compared with those of pre-operation. Radiologically, the global Cobb angle improved in both Group A (9.23 ± 4.94 on admission vs. 13.48 ± 2.52 at 12 months; p < 0.001) and Group B (5.97 ± 5.44 on admission vs. 13.81 ± 3.40 at 12 months; p < 0.001). Segment Cobb angle of the lesion improved in both Group A (-1.25 ± 3.08 on admission vs. 3.22 ± 1.29 at 12 months; p < 0.001) and Group B (-3.33 ± 4.15 on admission vs. 3.37 ± 1.98 at 12 months; p < 0.001). Both global and segmental Cobb angles remained stable at 3 months and 12 months after the surgery (p < 0.001). All patients achieved solid bone fusion. The anterior-only approach can be effective in mild CPS. For patients with severe kyphosis, posterior column involvement, or instability risks, two-staged CAPA might ensure thorough debridement, robust fixation, and sustained alignment correction.