Comparison of clinical and radiological outcomes of local morselized bone grafts and structural iliac bone grafts in the treatment of lumbar tuberculosis with posterior-only surgery

Abstract

Background: Many surgeons have reported results similar to those of anterior debridement and bone grafting in treating spinal tuberculosis in the lumbar region using only a posterior approach. However, there is still no consensus regarding bone graft methods. This study aims to compare the clinical and radiological outcomes of morselized versus structural iliac bone grafts in the treatment of lumbar tuberculosis via one-stage posterior surgery.

Methods: A retrospective study was performed with 82 patients with lumbar tuberculosis who had undergone posterior-only debridement, bone grafting, and instrumentation between January 2014 and June 2018. Morselized bone grafts were used in 43 patients, whereas structural iliac bone grafts were used in 39 patients. The clinical data and imaging results of the patients were compared between the two groups to evaluate the clinical effects of the two types of grafts.

Results: The operation time, blood loss and hospital stay values in the morselized bone group were significantly lower than those in the structural iliac bone group (p < 0.05). No significant differences were observed with respect to erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Cobb angle, or improvement of neurological function between the two groups. The VAS pain scores for low back and leg pain decreased significantly after the operation (p < 0.05). However, postoperatively, the VAS score was higher in the structural iliac bone group than in the morselized bone group, and there was no significant difference at the last follow-up between the two groups (p > 0.05). Bone fusion was achieved in 41 patients (95%) in the morselized bone group and 38 patients (97%) in the structural iliac bone group. There was no significant difference between the fusion rates of the two groups (p > 0.05).

Conclusion: The two graft techniques achieved comparable clinical outcomes in lumbar spinal tuberculosis treatment. However, the morselized bone graft was more beneficial in terms of reducing surgical trauma and postoperative complications.

Keywords: Iliac bone; Lumbar spinal tuberculosis; Morselized bone; Posterior approach; Surgery.

Fig. 1

A 68-year-old male with L2–3 tuberculosis. a The lateral X-ray film before surgery demonstrated intervertebral stenosis between the L2–3. b, c Preoperative CT and MRI showed that L2–3 vertebral bone destruction. d–f Postoperative X-ray and CT of a patient who underwent posterior internal fixation from T12 to L5 and morselized bone graft at L2–3. g, h X-ray at 26 months postoperative showing bone fusion between L2 and L3, without signs of tuberculosis recurrence and hardware failure

Fig. 2

A 39-year-old female with L4–5 tuberculosis. a The lateral X-ray film before surgery demonstrated intervertebral stenosis between the L4–5. b, c Preoperative CT and MRI showed that L4–5 vertebral bone destruction with paravertebral abscess. d–f Postoperative X-ray and CT of a patient who patient underwent posterior internal fixation from L2 to S1 and structural iliac bone graft at L4–5. g, h X-ray at 24 months postoperative showing bone fusion between L4 and L5, without signs of tuberculosis recurrence