Comparison of Three Interbody Fusion Methods Through Posterior Approach for Lower Lumbar Spinal Tuberculosis in Adults: a Study of Mid-Long Term Follow-Up

Abstract

Background: This study was conducted to compare mid-long term outcomes of three interbody fusion methods by way of posterior approach in adults with lower lumbar spinal tuberculosis.Methods: A total of 126 lower lumbar spinal tuberculosis patients were treated by one-stage posterior debridement, interbody fusion, and instrumentation. Of the three types of interbody bone grafts, 41 patients (group A) were treated with autogenous bone graft for interbody fusion , 45 patients (group B) were treated with allogeneic bone grafting, and the remaining 40 (group C) patients were treated with titanium mesh cage. Clinical and radiographic data were gathered and analyzed. Results: At the final follow-up, all patients were found to be completely cured. Neurological performance and quality of life were remarkably improved compared with those preoperative at the final follow-up. The preoperative lordosis angles of the three groups were significantly corrected compared with postoperative immediately values or those evaluated at the final follow-up. The correction loss of the group C was lower than those of groups A and B. All the patients obtained bone graft fusion; the fusion period of group B was longer than that of the other two groups. No significant differences among the three groups in adjacent segment degeneration rate were found at the last visit. Conclusions: This mid-long term follow-up study established that one-stage posterior debridement, interbody fusion, and instrumentation can effectively treat lower lumbar spinal tuberculosis. Moreover, intervertebral titanium mesh cage bone graft may provide better outcomes than autogenous or allogeneic bone graft. Background Spinal tuberculosis (TB), the most common extrapulmonary TB, accounts for about 50% of bone and joint TB [1]. This severe spinal disease often causes spinal instability, kyphosis, spinal nerve dysfunction, or even paraplegia [2]. Lower lumbar spine (L3-L5) is known to be the stress focus and an influencing site of TB. It has the characteristics of refractory, high disability, and recurrence rate, which seriously influences the quality of patients' life. Anti-TB drugs are used across the entire treatment period; a reasonable surgical treatment improves the cure rate [3].