Analyzing the clinical effect of one-stage anterior transplantation with iliac crest allograft or autograft in the treatment of thoracolumbar tuberculosis

Abstract

Objective To evaluate the safety, feasibility and clinical efficacy of one-stage anterior transplantation with iliac crest allograft or autologous in the treatment of thoracolumbar tuberculosis. Methods From January 2012 to June 2015, 235 cases of thoracolumbar tuberculosis were treated with allogeneic or autologous iliac crest graft combined with internal fixation during one-stage after radical debridement, which were reviewed retrospectively. These cases were divided into two groups: allograft group (162 cases) and autograft group (73 cases). In allograft group, there were 87 males and 75 females, with a mean age of 42.5(range 2-80) years. In autograft group, there were 41 males and 32 females, with a mean age of 40.3 (range 14-68) years. The operation time, bleeding volume, hospital stay, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level, visual analogue scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores, the changes of American Spinal Injury Association(ASIA) scale for neurological classification of spinal and graft fusion satisfaction rate in each groups were evaluated respectively before and after surgery. Results The operation time was (122.41±30.55) min in allograft group and (141.56±25.69) min in autograft group, the difference was statistically significant. The average hospital stay and bleeding volume were no significant difference between the two groups. In each group, VAS scores, JOA scores, ESR and CRP level and the changes of ASIA scale were significant difference between pre- and post-operation, but these index showed that there were no significant differences between the two groups. The mean ESR level was (16.46±7.39) mm/h in allograft group, and (13.61±6.85) mm/h in autograft group 3 months after the operation. The fusion time (8.13 ± 1.97) months in allograft group was significantly longer than that in autograft group (5.37±1.72) months, the difference was statistically significant. At final follow-up, the graft fusion satisfaction rate and the changes of ASIA showed no significant difference. Perioperative complications including gastrointestinal dysfunction in 5 cases (allograft group in 3cases; autograft group in 2cases), and pulmonary infection in 6 cases (allograft group in 4cases; autograft group in 2cases). Postoperative complications including kyphosis in 4 cases (allograft group in 3cases; autograft group in 1case), tuberculosis recurrence in 5 cases (allograft group in 3cases; autograft group in 2cases), sinus formation in 5 cases (allograft group in 3cases; autograft group in 2cases), chronic pain of the donor site in 6 cases (group autograft). Conclusion There was no significant difference between allogeneic iliac graft and autologous iliac graft in the treatment of thoracolumbar tuberculosis. Allogeneic iliac bone may be the ideal substitute of autologous iliac bone for the clinical treatment of thoracolumbar tuberculosis. Key words: Tuberculosis; Spinal fusion; Treatment outcome; Transplantation, homologous