ObjectiveTo compare the short-term effectiveness of one-stage posterior debridement with non-structural bone graft and structural bone graft in the treatment of single segment thoracic tuberculosis.MethodsThe data of 61 patients with single segment thoracic tuberculosis, who were treated by one-stage posterior debridement, bone graft fusion, and internal fixation between June 2011 and August 2015, was retrospectively analyzed. All of them, 26 cases were treated with structural bone graft (group A) and 35 cases with non-structural bone graft (group B). No significant difference was found between the two groups in gender, age, disease duration, comorbidity, involved segments, paravertebral abscess, and preoperative American Spinal Injury Association (ASIA) grade, C reactive protein (CRP), visual analogue scale (VAS) score, and Cobb angle of involved segments (P>0.05). But the preoperative erythrocyte sedimentation rate (ESR) in group B was significantly lower than that in group A (t=3.128, P=0.003). The operation time, intraoperative blood loss, hospitalization stay, VAS score, ESR, CRP, ASIA grade, postoperative complications, Cobb angle of involved segments and its correction rate and loss rate, and bone fusion time were recorded and compared between the two groups.ResultsCompared with group A, group B had shorter operation time, less intraoperative blood loss, and longer hospitalization stay, showing significant differences (P<0.05). The follow-up time of group A was (36.3±10.0) months, which was significantly longer than that of group B [(18.4±4.2) months] (t=10.722, P=0.000). At last follow-up, the VAS score, ESR, and CRP in the two groups all significantly improved when compared with those before operation (P<0.05); the CRP of group B was significantly higher than that of group A (t=–2.947, P=0.005); but there was no significant difference in ESR and VAS score between the two groups (P>0.05). At last follow-up, the ASIA grade of the two groups significantly improved when compared with those before operation, and there was no significant difference between the two groups (Z=–1.104, P=0.270). There were 9 cases and 10 cases of complications in groups A and B, respectively, and there was no significant difference (χ2=0.254, P=0.614). The Cobb angle in group B was significantly higher than that in group A at 3 days after operation (t=–2.861, P=0.006), but there was no significant difference in Cobb angle between the two groups at last follow-up (t=–1.212, P=0.230). The postoperative correction rate and loss rate of Cobb angle in group A were higher than those in group B, and there was a significant difference in the loss rate between the two groups (t=2.261, P=0.031). All patients got bone graft fusion and the bone fusion time of group B was significantly shorter than that of group A (t=4.824, P=0.000).ConclusionNon-structural and structural bone graft can both achieve good effectiveness in the treatment of single segment thoracic tuberculosis, but the former has the advantages of less surgical trauma and shorter fusion time.
Objective To compare the clinical efficacy, safety, mechanical stability and bone defect repair ability of one-stage posterior lesion removal, non-structural bone grafting and internal fixation in the treatment of single-gap thoracolumbar tuberculosis with different bone defect ranges. Methods A cohort of patients with single intervertebral space thoracolumbar tuberculosis was retrospectively selected, who were treated by one-stage posterior lesion removal, non-structural bone grafting and internal fixation at the Third People’s Hospital of Chengdu between January 2010 and December 2023. Patients with spinal tuberculosis bone defects covering less than 50% of the vertebral body were classified as Group A, while those with bone defects no less than 50% were categorized as Group B. Clinical indicators, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), Visual Analogue Scale (VAS) score for pain, Oswestry Disability Index (ODI), Cobb angle, American Spinal Injury Association (ASIA) classification, and bone graft fusion time were compared between the two groups. Results A total of 70 patients met the inclusion criteria, with 40 in Group A and 30 in Group B. The follow-up duration was (19.1±3.9) months in Group A and (27.5±9.2) months in Group B, with a statistically significant difference (t=?5.195, P<0.001). No statistically significant difference was observed in gender, age, or preoperative and final follow-up CRP, ESR, or VAS scores between the groups (P>0.05). Surgical complications, time to ambulation, and hospitalization duration also showed no significant differences (P>0.05). At the final follow-up, all parameters including CRP, ESR, VAS scores, ODI, ASIA classification, and local Cobb angle demonstrated marked improvement compared to preoperative levels (P<0.05). Notably, both groups exhibited statistically significant loss of local Cobb angle at 1 week postoperatively (P<0.05), though no significant difference was found in postoperative correction rates or loss rates (P>0.05). Group A showed statistically significant advantages over Group B in surgical duration, intraoperative bleeding, internal fixation segments, and bone healing time (P<0.05). Conclusions The clinical efficacy of one-stage posterior lesion removal combined with non-structural bone grafting and internal fixation for single-gap thoracolumbar tuberculosis with varying bone defect ranges is favorable. The reliable mechanical stability ensures early recovery of daily living abilities, with the procedure being simple to perform and having fewer complications. Compared with the group with smaller bone defects (<50% vertebral body), the group with larger bone defects (≥50%) requires more extensive surgical trauma, necessitates longer segmental internal fixation, and exhibits prolonged bone healing time. Clinical application demands comprehensive evaluation and cost-benefit analysis.
