Mono-segment fixation method versus short-segment fixation methods, in treatment of mono-segmental lumbar tuberculosis; using titanium mesh cage with interbody fusion retrospective case-control study.

Abstract

Background ： 1/3rd-2/3rd of the remaining vertebral height can hold and withstand the standard pedicle screws; some surgeons have adopted affected vertebral fixation to avoid the complications of both long and short segment fixation during surgical correction of lumbar tuberculosis (TB).This study aimed to compare efficacy of mono-segment-fixation versus the short-segment fixation methods with the use of titanium mesh-cage (TMCs) and interbody fusion in the treatment of mono-segmental lumbar spinal TB via single stage posterior-only approach. Methods ： A retrospective review was done among 34 lumbar spinal TB patients. These patients underwent debridement, interbody fusion with (TMCs) by either Mono-segment fixation or short-segment fixation methods. Eighteen patients underwent mono-segment fixation method, group (A). While 16 patients underwent short-segment fixation method, group (B). Fusion, deformity correction, and decompression were done within the affected segment in group (A), while for group (B) fusion extended one level above and below the affected vertebrae . Operation time, intra-operative blood loss, degree of deformity correction and neurological functions were analyzed. Results: Comparing group (A) vs (B), average operation time in minutes (mins) for group A was 144.2±16.5, group B was 170.3 ± 25.0 (P=0.001). Average intraoperative blood loss in milliliter (mls) was 502.8±151.9 for group (A) and 742.5±143.2 for group (B) (p ˂0.05). The mean cobb’s angle between group A versus group B; preoperative was 23.8 ± 6.5 0 vs 22.2±9.2 0 (p=0.6), immediate post operatively was 8.0±3.5 0 vs 8.3±5.7 0 (p=0.847) and at final follow-up was 8.9±3.1 0 vs 9.2 ± 5.9 0 (p=0.866) respectively. Correction rate between group (A) vs group (B) was 15.7±3.8 0 vs 13.9±5.5 0 (p=0.285) and loss of correction was 1.2±0.7 0 vs 1.1±0.7 (p=0.817) respectively. No significant differences in neurological recovery between the two groups were founds. Conclusion: Under precise conditions: mono-segment fixation method, debridement, interbody fusion with TMCs, and posterior instrumentation can effectively reconstruct the spine, maintain stability and correct kyphosis deformity similar to short-segment fixation method. Also, it can relieve pain and improve neurological symptoms. When used in combination with anti-TB chemotherapy in the treatment of mono-segmental lumbar TB via a single-stage posterior-only approach.