Table_2_Spinous Process Combined With a Titanium Mesh Cage as a Bone Graft in the Stability Reconstruction of Lumbar or Lumbosacral Spinal Tuberculosis.DOCX

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.

研究背景：自体骨移植（autogenous bone graft）曾被用于脊柱结核（spinal tuberculosis, STB）的前路重建，其兼具临床优势与局限性。本研究介绍一种新型术式：以棘突（spinous process, SP）联合钛网笼（titanium mesh cage, TMC）作为植骨材料，用于腰椎或腰骶椎脊柱结核的稳定性重建。本研究通过回顾性对比接受SP+TMC术式、传统TMC植骨术或异体骨植骨术的患者，从安全性、有效性与成本效益维度，评估SP+TMC是否可作为一种可行的替代治疗方案。

研究方法：2010年至2018年，本研究纳入69例接受单节段腰椎或腰骶椎一期后路清创植骨内固定术的患者。其中12例接受棘突联合钛网笼植骨（SP+TMC组，A组），30例仅接受钛网笼植骨（TMC组，B组），27例接受异体骨植骨（C组）。本研究记录的观察指标包括：手术时长、失血量、住院时长、视觉模拟评分（visual analog scale, VAS）、Oswestry功能障碍指数（Oswestry Disability Index, ODI）、红细胞沉降率（erythrocyte sedimentation rate, ESR）、C反应蛋白（C-reactive protein, CRP）、美国脊髓损伤协会损伤分级（American Spinal Injury Association Impairment, ASIA）、末次随访时长及术后并发症。影像学评估指标包括：固定节段数、置入椎弓根螺钉数量、Cobb角、骨盆参数及骨融合时间。所有结局指标均采用SPSS 25统计软件进行分析。

研究结果：与异体骨植骨组相比，SP+TMC组的固定节段更少、置入椎弓根螺钉数量更少、手术时长更短、失血量更少，且住院成本显著更低。此外，钛网笼组的临床结局与异体骨组相当，且具备更低的经济成本。

研究结论：本研究表明，与钛网笼植骨或异体骨植骨相比，采用棘突联合钛网笼作为植骨材料，用于单节段腰椎或腰骶椎脊柱结核的外科治疗，是一种有效且可靠的术式，可有效恢复脊柱稳定性。此外，该术式是一种具备成本效益的结构性植骨方法，尤其适用于发展中国家的患者。