ObjectiveTo systematically evaluate the effectiveness of anterior versus posterior approaches with one-stage debridement and bone grafting for surgical treatment of spinal tuberculosis. MethodsDatabases including PubMed, MEDLINE, Ovid, Elsevier, CBM, WanFang Data, CNKI and VIP were electronically searched from 2004 to 2015 to collect relevant clinical studies about the effectiveness of anterior versus posterior approaches with one-stage debridement and bone grafting for surgical treatment of spinal tuberculosis. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies, and then meta-analysis was performed using RevMan 5.2 software. ResultsA total of 11 studies involving 1 063 patients were included. The results of meta-analysis showed that: correction of Cobb angle with the posterior approach was significantly larger than that of anterior approach (MD=-2.78, 95%CI -3.73 to -1.82, P<0.000 01); the allograft fusion time of anterior approach was shorter than that of posterior approach (MD=-0.21, 95%CI -0.35 to -0.08, P=0.002). But there were no significant differences between the two groups in operation time, intraoprative blood loss, loss of Cobb angle at final follow-up and time of total hospital stay (all P values >0.05). ConclusionPosterior approach can correct the Cobb angle significantly for the spinal tuberculosis patients with kyphosis, and anterior approach has a shorter allograft fusion time, but it is not able to correct the deformity of the patient to maintain the normal sequence of the spine. For the quantity and quality limitation of the included studies, this conclusion still needs to be proved by conducting more high quality studies.