Minimum 5-Year Follow-Up Outcomes for Comparison Between Titanium Mesh Cage and Allogeneic Bone Graft to Reconstruct Anterior Column Through Posterior Approach for the Surgical treatment of Thoracolumbar Spinal Tuberculosis with Kyphosis.

ABSTRACT

OBJECTIVE: We aimed to compare the clinical efficacy of titanium mesh cage with that of allogeneic bone graft to reconstruct the anterior column through posterior approach for the surgical management of patients with thoracolumbar spinal tuberculosis with kyphosis. METHODS: From January 2011 to March 2013, 57 patients with single-segment or two-segments thoracolumbar spinal tuberculosis with kyphosis were treated by debridement, interbody graft, posterior instrumentation, and fusion via a posterior-only procedure. Twenty-four patients in group A were treated with allogeneic bone graft to reconstruct the anterior column, whereas 33 patients in group B were treated with titanium mesh cage. The clinical efficacy was evaluated by visual analog scale (VAS), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neurologic function recovery, kyphotic Cobb angle, and postoperative complications. RESULTS: The mean follow-up was 72.4 months. Neurologic function was significantly improved after surgery in all cases. There were significant differences of VAS, ESR, and CRP between preoperation and postoperation at the final follow-up, with no significant difference between the two groups. The kyphotic Cobb correction was significantly improved when compared with those in preoperation, but there was no significant difference between the two groups. One patient in group A with two segments involved experienced graft fracture. He had anterior bone graft with titanium mesh cage. CONCLUSIONS: Minimum 5-year follow-up outcomes showed that one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation, and fusion is an effective treatment for patients with thoracolumbar spinal tuberculosis accompanied by kyphosis. It may obtain better clinical efficacy than allogeneic bone graft for treating two-segments thoracolumbar spinal tuberculosis.