Could Nonstructural Interbody Fusion Be an Alternative Surgical Technique for Treatment of Single Segment Thoracic and Lumbar Spinal Tuberculosis via a Posterior- Only Approach?

• Published in: World neurosurgery Vol. 130; pp. e316 - e323
• Main Authors: Suya, Danny, Shao, Liwei, Gu, Rui, Xu, Qinli, Luo, Wenqi
• Format: Journal Article
• Language: English
• Published: United States 01.10.2019
• Subjects: Adult; Aged; Cohort Studies; Female; Follow-Up Studies; Humans; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - surgery; Male; Middle Aged; Retrospective Studies; Spinal Fusion - methods; Thoracic Vertebrae - diagnostic imaging; Thoracic Vertebrae - surgery; Treatment Outcome; Tuberculosis, Spinal - diagnostic imaging; Tuberculosis, Spinal - surgery; Young Adult; Interbody fusion; Thoracic and lumbar spinal tuberculosis; Nonstructural; Posterior approach only; Structural
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2019.06.072

To compare and evaluate the efficacy and safety of nonstructural versus structural interbody fusion, using a combination of autograft and allograft bone for treatment of single segment thoracic and lumbar spinal tuberculosis (TB) via a posterior-only approach. We retrospectively analyzed 37 patients who were surgically treated in our department for thoracic and lumbar spinal TB between March 2015 and March 2018 and met our inclusion criteria. Eighteen of these 37 patients underwent nonstructural interbody fusion (group A), whereas the other 19 underwent structural interbody fusion with the aid of titanium mesh cages (group B). We compared and analyzed visual analog scale scores, erythrocyte sedimentation rate, blood loss, operation time, bone fusion rates, and correction angles. The average duration of follow-up was 20.33 ± 4.73 months (range, 12-26 months) in group A and 19.63 ± 4.63 months (range, 12-26 months), in group B. All patients showed significant improvement in neurologic function by 1 or 2 grades. Bone fusion was achieved in all patients, with no statistically significant difference between the 2 groups (P > 0.05). However, there were significant between-group differences in operation time (mean, 196.28 ± 43.49 minutes [range, 128-300 minutes] in group A vs. 223.26 ± 46.34 minutes [range, 150-300 minutes] in group B; P < 0.05) and estimated blood loss (mean, 474.44 ± 224.37 mL [range, 200-900 mL] in group A vs. 585.79 ± 378.82 mL [range, 200-1500] in group B; P < 0.05). The 2 surgical techniques may well have achieved similar results in terms of decreasing bone fusion time, improving neurologic function, and correcting kyphotic angles. However, the nonstructural interbody fusion technique exhibited less blood loss and faster operation time, and thus could serve as an alternative surgical technique for treatment of single-segment thoracic and lumbar spinal TB.