A meta-analysis of the safety and effectiveness of titanium mesh versus bone graft alone for the treatment of thoracolumbar tuberculosis

He, Zhian; Ou, Yufu; Hou, Bo; Wei, Jianxun; Mu, Xiaoping

doi:10.1007/s00586-019-06260-2

Cited by 9 publications

(9 citation statements)

References 24 publications

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“…Previous studies have investigated the difference in surgical outcomes among different bone grafting procedures by Du, Srivastava, et al [ 17 – 20 ], whereas the meta-analysis in this field remains limited. To the best of our knowledge, among the above research, only one study reported by He et al [ 10 ] compared the surgical effects of AM and TM using a meta-analysis. Their findings suggest that both TM and AM alone are effective for the treatment of thoracolumbar spinal tuberculosis based on safety, but nonsupport the superiority of TM or AM reported in previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…However, we reviewed the pieces of literature and found that evidence-based medical evidence for bone grafting in spinal tuberculosis is difficult to identify. So far there is only a meta-analysis of AM and TM in the treatment of spinal tuberculosis, which does not include AG unfortunately [ 10 ]. To investigate the clinical efficacy and surgical safety of different bone grafting modalities (AG, AM, and TM) for the treatment of spinal tuberculosis, a network meta-analysis was performed to assess the effectiveness and guide the choice of bone grafts in the future.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of clinical efficacy and surgical safety among three bone graft modalities in spinal tuberculosis: a network meta-analysis

Qin

Wang

et al. 2023

J Orthop Surg Res

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Background Autogenous granular bone graft (AG), autogenous massive bone graft (AM), and titanium mesh bone graft (TM) are the three commonly utilized bone implant methods for spinal tuberculosis. However, the gold standard is still controversial. Therefore, this study aimed to compare the clinical efficacy and surgical safety of three primary bone graft modalities. Methods For systematic literature review, several databases, including PubMed, Embase, and Web of Science, were searched up to December 2022. Stata (version 14.0) was employed for data analysis. Results Our network meta-analysis included 517 patients from 7 articles whose qualities are acceptable based on our quality assessment criteria. In direct comparison, AG was associated with a shorter operation time (MD = 73.51; CI 30.65–116.37) and a lesser blood loss (MD = 214.30; CI 7.17–421.44) than AM. TM had fewer loss of Cobb angle than AG (MD = 1.45; CI 0.13–2.76) and AM (MD = 1.21; CI 0.42–1.99). Compared with AG, TM (MD = 0.96; CI 0.06–1.87) was related to a shorter bone graft fusion time. In indirect comparison, for the clinical parameters, the rank of CRP (from best to worst) was as follows: TM (58%) > AM (27%) > AG (15%), the rank of ESR (from best to worst) was as follows: AG (61%) > AM (21%) > TM (18%), and the rank of VAS (from best to worst) was as follows: AG (65%) > TM (33%) > AM (2%). In the aspect of surgical data, what is noteworthy is that AG showed less blood loss [AG (93%) > TM (6%) > AM (1%)], operative time [AG (97%) > TM (3%) > AM (0)], and complications [AG (75%) > TM (21%) > AM (4%)] than AM and TM. As for imaging parameters, the rank of the loss of Cobb angle (from best to worst) was as follows: TM (99%) > AM (1%) > AG (0). Moreover, TM showed a shorter bone graft fusion time than AM and AG: TM (96%) > AM (3%) > AG (1%). Conclusions The results indicated that AG might be the optional treatment for spinal tuberculosis owing to the outcomes of surgical safety. Moreover, TM is another right choice which can significantly reduce the loss of Cobb angle and shorten bone graft fusion time with long‐term follow‐up.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of clinical efficacy and surgical safety among three bone graft modalities in spinal tuberculosis: a network meta-analysis

Qin

Wang

et al. 2023

J Orthop Surg Res

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“…However, the spinal pedicle screw system only provides temporary stability, with long-term stability primarily relying on bony fusion of the vertebral defect. At present, the most commonly used bone grafts for STB surgery are allogeneic bone grafts (allografts), autogenous iliac bone grafts, and titanium mesh cages (TMCs) filled with allogeneic or autogenous bone ( 9 , 10 ), each of which has benefits and limitations. The autogenous iliac bone graft is considered the gold standard due to its high bone fusion rate, but it may result in additional surgical trauma and complications at the donor site ( 10 , 11 ).…”

Section: Introductionmentioning

confidence: 99%

Spinous Process Combined With a Titanium Mesh Cage as a Bone Graft in the Stability Reconstruction of Lumbar or Lumbosacral Spinal Tuberculosis

et al. 2022

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BackgroundAutogenous bone grafts, such as iliac bone or rib struts, have been used in the anterior reconstruction of spinal tuberculosis (STB) and have their own benefits and limitations. Here, we introduced a new method, the spinous process (SP), combined with a titanium mesh cage (TMC) as a bone graft in the stability reconstruction of lumbar or lumbosacral STBs. By retrospectively comparing patients who received SP+TMC to traditional TMC bone grafts or allogeneic bone grafts in terms of safety, efficacy and cost-effectiveness, we aimed to evaluate whether SP+TMC could be a possible alternative method.MethodsFrom 2010 to 2018, 69 patients who underwent one-stage posterior debridement with grafts and internal fixation within a single lumbar or lumbosacral segment were included in this study. Twelve patients who received SP combined with a TMC (SP+TMC, group A), 30 patients who received a TMC only (group B), and 27 patients who received allografts (group C) were included. Measurements including operative time, blood loss, length of hospital stay, visual analog scale (VAS) score, Oswestry Disability Index (ODI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), American Spinal Injury Association Impairment (ASIA) grade, final follow-up (FFU) duration and postoperative complications were recorded. Radiological measurements, including the number of segments fixated, the number of pedicle screws used, the Cobb angle, pelvic parameters, and the bony fusion time, were reviewed. All outcomes were analyzed using SPSS 25.ResultsWe found that the SP+TMC group had fewer fixation segments, fewer pedicle screws implanted, a shorter operative time, reduced blood loss, and a considerably lower hospital cost than allografts. In addition, the TMC group had a comparable clinical outcome with the TMC group regarding lower economic cost.ConclusionOur study demonstrates that compared to a TMC or allograft, the use of SP combined with a TMC as a bone graft is an effective and reliable approach for the surgical management of one-level lumbar or lumbosacral spinal tuberculosis, leading to effective restoration of spinal stability. Furthermore, this approach is a cost-effective structural bone grafting method, especially for patients in developing countries.

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“…Spinal has been the most common site of skeletal tuberculosis, and STB amounts for approximately 50-60% of the cases of extrapulmonary musculoskeletal TB (EPTB) [ 1 , 2 ]. STB often leads to irreversible neurological injury, including paralysis, resulting in serious social and economic problems [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Expression and Clinical Significance of lncRNA NEAT1 in Patients with Spinal Tuberculosis

et al. 2022

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Background. Spinal tuberculosis (STB) often leads to irreversible neurological injury, resulting in serious social and economic problems. With the emergence of drug resistance, the management becomes even more challenging, given the treatment courses are generally longer for skeletal than pulmonary tuberculosis (PTB). The development and validation of nonsputum biomarkers for diagnosis and tailoring of treatment duration to enable personalized and evidence-based management of such diseases to improve treatment outcomes is being called for globally. Studies have demonstrated that lncRNA NEAT1 was highly expressed in pulmonary tuberculosis (TB) and was related to its progression and recovery. However, the expression and clinical significance of lncRNA NEAT1 in STB remains unclear. Methods. The relative expression of lncRNA NEAT1 was quantified by relative real-time reverse transcription PCR (RT-PCR). The prognostic value was assessed by receiver-operating characteristic (ROC) curve analysis. Pearson and Spearman correlation coefficient and chi-square test were used to analyze the correlation between the lncRNA NEAT1 expression and the clinical characteristics. Univariate and multivariate logistic regression analyses were used to analyze independent predictors of STB recurrence. Results. Compared with normal healthy individuals, the expression level of lncRNA NEAT1 in peripheral blood and granulomatous tissues of STB patients was significantly increased. The results of the in vitro Mycobacterium tuberculosis- (Mtb-) infected cell model showed that the expression level of lncRNA NEAT1 was significantly upregulated in macrophages infected with Mtb, and the difference was statistically significant compared with Mtb-uninfected group. The expression level of lncRNA NEAT1 in granulomatous tissue of STB was significantly higher than that in peripheral blood. The expression of lncRNA NEAT1 was related to segments of the lesions, paraspinal abscesses, anti-TB treatment, drug resistance, interleukin-6 (IL-6), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Multivariate analysis results showed that relatively high expression of lncRNA NEAT1_1, the shorter transcript of the NEAT1 gene, was an independent prognostic factor of STB outcome. Conclusion. LncRNA NEAT1 was highly expressed in peripheral blood mononuclear cells (PBMCs) and granulomatous tissue from patients with STB, as well as in Mtb-infected THP-1 cell lines. LncRNA NEAT1 expression was significantly associated with clinical characteristics (paraspinal abscesses, segments of the lesions and anti-TB treatment, IL-6, CRP, and ESR) of patients in STB. Increased expression of lncRNA NEAT1_1 predicted good prognosis of STB and might become a prognostic biomarker for STB.

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A meta-analysis of the safety and effectiveness of titanium mesh versus bone graft alone for the treatment of thoracolumbar tuberculosis

Cited by 9 publications

References 24 publications

Comparison of clinical efficacy and surgical safety among three bone graft modalities in spinal tuberculosis: a network meta-analysis

Comparison of clinical efficacy and surgical safety among three bone graft modalities in spinal tuberculosis: a network meta-analysis

Spinous Process Combined With a Titanium Mesh Cage as a Bone Graft in the Stability Reconstruction of Lumbar or Lumbosacral Spinal Tuberculosis

Expression and Clinical Significance of lncRNA NEAT1 in Patients with Spinal Tuberculosis

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