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Single posterior surgical management for lumbosacral tuberculosis: titanium mesh versus iliac bone graft: A retrospective case-control study.

Abstract Recently, the one-stage posterior approach for treating spinal tuberculosis (TB) has gained popularity. However, large bony defects after debridement remain a major challenge in posterior surgery. The present retrospective study aims to compare the clinical outcomes of posterior-only surgical management by titanium mesh versus iliac bone grafts for treating lumbosacral TB. This was a retrospective cohort study. From January 2006 to April 2012, 36 patients with lumbosacral TB were treated at our department. The 36 cases were divided into 2 groups: 17 patients in Group A (titanium mesh) underwent one-stage posterior internal fixation, debridement, and titanium mesh bone fusion. The 19 patients in Group B (iliac bone graft) underwent posterior instrumentation, debridement, and iliac bone graft in a single procedure. The clinical and radiographic results for the 2 groups were analyzed and compared. The mean year of patients was 49.9 ± 15.4 months in group A and 55.5 ± 12.6 months in group B. All patients were followed up for an average of 47.3 ± 8.1 months (range 36-60 months). Spinal TB was completely cured and no intraspinal infection and central nervous system complications of TB infection occurred. Bone fusion was achieved 6.4 ± 1.9 months in group A and 7.8 ± 2.1 months in group B. There was no significant statistical difference in bone fusion between the 2 groups (P > .05). The Oswestry Disability Index score (ODI) significantly improved between the preoperative and the last visit in either group. However, no significant difference was observed between the 2 groups at last visit (P > .05). There were significant differences between groups regarding the postoperative lumbosacral angle and angle correction loss at the final follow-up (P < .05). The average operative complication rate of Group A was less than that of Group B. Both iliac bone and titanium mesh can effectively construct anterior column defects in posterior surgery. The titanium mesh has the advantage of minor surgical invasion, effective reconstruction of large defects, and ideal sagittal alignment in lumbosacral TB for patients with osteoporosis and poor iliac bone quality.
PMID
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Authors

Mayor MeshTerms

Surgical Mesh

Keywords
Journal Title medicine
Publication Year Start

 



PMID- 29390579
OWN - NLM
STAT- MEDLINE
DCOM- 20180212
LR  - 20180212
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 51
DP  - 2017 Dec
TI  - Single posterior surgical management for lumbosacral tuberculosis: titanium mesh 
      versus iliac bone graft: A retrospective case-control study.
PG  - e9449
LID - 10.1097/MD.0000000000009449 [doi]
AB  - Recently, the one-stage posterior approach for treating spinal tuberculosis (TB) 
      has gained popularity. However, large bony defects after debridement remain a
      major challenge in posterior surgery. The present retrospective study aims to
      compare the clinical outcomes of posterior-only surgical management by titanium
      mesh versus iliac bone grafts for treating lumbosacral TB. This was a
      retrospective cohort study. From January 2006 to April 2012, 36 patients with
      lumbosacral TB were treated at our department. The 36 cases were divided into 2
      groups: 17 patients in Group A (titanium mesh) underwent one-stage posterior
      internal fixation, debridement, and titanium mesh bone fusion. The 19 patients in
      Group B (iliac bone graft) underwent posterior instrumentation, debridement, and 
      iliac bone graft in a single procedure. The clinical and radiographic results for
      the 2 groups were analyzed and compared. The mean year of patients was 49.9 +/-
      15.4 months in group A and 55.5 +/- 12.6 months in group B. All patients were
      followed up for an average of 47.3 +/- 8.1 months (range 36-60 months). Spinal TB
      was completely cured and no intraspinal infection and central nervous system
      complications of TB infection occurred. Bone fusion was achieved 6.4 +/- 1.9
      months in group A and 7.8 +/- 2.1 months in group B. There was no significant
      statistical difference in bone fusion between the 2 groups (P &gt; .05). The
      Oswestry Disability Index score (ODI) significantly improved between the
      preoperative and the last visit in either group. However, no significant
      difference was observed between the 2 groups at last visit (P &gt; .05). There were 
      significant differences between groups regarding the postoperative lumbosacral
      angle and angle correction loss at the final follow-up (P &lt; .05). The average
      operative complication rate of Group A was less than that of Group B. Both iliac 
      bone and titanium mesh can effectively construct anterior column defects in
      posterior surgery. The titanium mesh has the advantage of minor surgical
      invasion, effective reconstruction of large defects, and ideal sagittal alignment
      in lumbosacral TB for patients with osteoporosis and poor iliac bone quality.
CI  - Copyright (c) 2017 The Authors. Published by Wolters Kluwer Health, Inc. All
      rights reserved.
FAU - Yin, Xin H
AU  - Yin XH
AD  - Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University College
      of Medicine, Xi'an, China.
FAU - Liu, Zhong K
AU  - Liu ZK
FAU - He, Bao R
AU  - He BR
FAU - Hao, Ding J
AU  - Hao DJ
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - D1JT611TNE (Titanium)
SB  - AIM
SB  - IM
MH  - Bone Transplantation/instrumentation/*methods
MH  - Case-Control Studies
MH  - Female
MH  - Humans
MH  - Ilium/*transplantation
MH  - Lumbar Vertebrae/microbiology/surgery
MH  - Lumbosacral Region/microbiology/*surgery
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Sacrum/microbiology/surgery
MH  - *Surgical Mesh
MH  - Titanium
MH  - Tuberculosis, Spinal/*surgery
PMC - PMC5758281
EDAT- 2018/02/03 06:00
MHDA- 2018/02/13 06:00
CRDT- 2018/02/03 06:00
PHST- 2018/02/03 06:00 [entrez]
PHST- 2018/02/03 06:00 [pubmed]
PHST- 2018/02/13 06:00 [medline]
AID - 10.1097/MD.0000000000009449 [doi]
AID - 00005792-201712220-00166 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Dec;96(51):e9449. doi: 10.1097/MD.0000000000009449.