Titanium Mesh Versus Autogenous Iliac Bone Graft For Vertebra Defects In Thoracic And Lumbar Spinal Tuberculosis

[OBJECTIVE] To explore the clinical efficacy by posterior debridement,bone graft fusion and pedicle screw fixation for treating thoracic and lumbar spinal tuberculosis,and to compare therapeutic effects of titanium mesh and autogenous iliac bone graft alone to restore vertebra defects.[METHODS] 49 patients with single-segment spinal tuberculosis treated by posterior debridement,interbody fusion and posterior instrumentation at the same institution from January 2011 to December 2013.25 patients in group A underwent posterior focus clearance,internal fixation,and reconstruction using formed titanium mesh.24 cases in group B underwent posterior operative reconstruction using autogenous iliac bone graft alone.The clinical efficacy was evaluated based on the visual analog scale(VAS),the Oswestry Disability Index(ODI),neurological status,bony fusion,intervertebral height,Cobb angle,postoperative complications and so on.[RESULTS] Final follow up was done on 49 patients with an average of 35.3 months(range from 15 to 56 months).spinal tuberculosis was completely cured,and the solid bony fusion was achieved for all patients.angular correction and restoration of intervertebral heights significantly improved compared with preoperation.There were no significant difference between two groups(P>0.05).There was a less of the loss of angular correction and intervertebral height in group A when compared with group B(P<0.05).The neurological outcome improved after surgery.There were cerebrospinal fluid leakage(1 case in group A),sinus formation(1 case in each of group A and group B),and intervertebral infection(1 case in group B),but no implant failure or donor site complications was found in any patient.[CONCLUSIONS] Posterior surgery achieved good clinical results for treating thoracic and lumbar spinal tuberculosis.When single-segment thoracic and lumbar spinal tuberculosis involved,titanium mesh or autogenous iliac bone graft for reconstructing vertebra defects is a good alternative.