Comparison of short-term effectiveness of structural and non-structural bone graft fusion in treatment of single segment thoracic tuberculosis

Abstract

To 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. The 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. Compared 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 ( χ 2=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). Non-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.