The efficacy of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis

Abstract

Background: The bony fusion of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis has not been explained in detail. We aimed to analyze the efficacy of bony fusion of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis. Methods: We treated 32 thoracic or thoracolumbar tuberculosis patients by one-stage posterior debridement, allograft bone graft using titanium mesh, posterior instrumentation, and fusion from May 2011 to September 2015. The American Spinal Injury Association neurological classification, visual analog scale, and Oswestry disability index scores were analyzed preoperatively, postoperatively, and at final follow-up. The Cobb angles were recorded to evaluate the kyphosis correction and the loss of correction. The bony fusion was evaluated by X-ray and computed tomography images, and the bony fusion classifications were recorded. Results: All patients had pain relief. The erythrocyte sedimentation rate, C-response protein, and hepatorenal function were normal at final follow-up. The American Spinal Injury Association neurological classification, visual analog scale, and Oswestry disability index scores were improved in all the patients. All patients achieved bone fusion. Twenty-eight patients achieved complete fusion (Grade I), whereas only four patients achieved partial fusion (Grade II). The preoperative Cobb angle was 33.6 ± 9.3°. The Cobb angle was reduced to 10.6 ± 2.6°postoperatively and was found to be 11.4 ± 3.1°at the final follow-up. The mean angle correction was 23.0 ± 8.9°, and the correction rate was 66.2 ± 12.2%. The mean angle lost was 0.8 ± 0.9°, and the lost rate was 5.8 ± 5.4% at the final follow-up. Conclusions: Allograft bone using titanium mesh in the posterior-only surgical treatment is effective for patients with thoracic and thoracolumbar spinal tuberculosis. It can correct kyphosis, and most patients can achieve complete bony fusion.

Comparison of bundled rib implants and titanium mesh implants in thoracic spinal tuberculosis surgery

“…Wang B et al [13] reported 32 cases of thoracic spinal tuberculosis surgically treated using the simple posterior approach to perform focal debridement combined with titanium mesh and allograft bone graft fusion. Satisfactory clinical outcomes and good correction of the posterior convexity deformity were achieved in all patients.…”

Effectiveness and safety analysis of titanium mesh grafting versus bone grafting in the treatment of spinal Tuberculosis: a systematic review and meta-analysis

“…This preference can be attributed primarily to the limitations of drug therapy, which often struggles to achieve effective medication concentration in the lesion area without causing adverse effects on other organs [ 35 , 36 ]. Studies have shown that titanium mesh grafting has better biocompatibility and can rapidly stabilize the affected segments without causing pathology at the grafting site, making it widely used in the clinical treatment of spinal tuberculosis [ 9 , 16 , 37 ]. Meanwhile, simple bone grafting has its limitations, such as limited autologous bone quantity and potential complications from donor site bleeding and potential complications in the graft area [ 38 ]; allografts are associated with complications such as delayed healing and infection [ 39 ].…”

“…In spinal tuberculosis surgery, allografts can potentially replace autografts. Previous studies have indicated that titanium mesh offers superior anterior column support and has a lower rate of kyphotic angle loss, especially beneficial for patients with osteoporosis and inferior iliac bone quality [ 9 – 16 ]. With the advancement of biomaterials and bone tissue engineering, a variety of grafting materials are now employed in the surgical treatment of spinal tuberculosis.…”