Comparative evaluation of multi-fold rib and structural iliac bone grafts in single-segment thoracic and thoracolumbar spinal tuberculosis: clinical and radiological outcomes

Abstract

Objective: To compare clinical and radiological outcomes of multi-fold rib and structural iliac bone grafts, the primary autologous graft techniques in anterolateral-only surgery for single-segment thoracic and thoracolumbar spinal tuberculosis.

Methods: This retrospective study included 99 patients treated from January 2014 to March 2022, categorized into 64 with multi-fold rib grafts (group A) and 35 with structural iliac bone grafts (group B). Outcomes assessed included hospital stay, operation time, intraoperative blood loss, postoperative drainage, complications, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the Visual Analog Scale (VAS) for pain, the Oswestry Disability Index (ODI), bone fusion time, and the American Spinal Injury Association (ASIA) impairment scale grade. Segmental kyphotic angle and intervertebral height were measured radiologically before surgery and follow-up.

Results: The mean follow-up was 63.50 ± 26.05 months for group A and 64.97 ± 26.43 months for group B (P > 0.05). All patients had achieved a clinical cure. Group A had a shorter operation time (P = 0.004). Within one week post-surgery, group B reported higher VAS scores (P < 0.0001). Neurological performance and quality of life significantly improved in both groups. No significant differences were observed in segmental kyphotic angle and intervertebral height between the groups pre- and postoperatively (P > 0.05). However, group A showed a greater segmental kyphotic angle at the final follow-up, while group B had better maintenance of kyphotic angle correction and intervertebral height (P < 0.05). Bone fusion was achieved in all patients without differences in fusion time (P > 0.05).

Conclusions: Multi-fold rib grafts resulted in shorter operation times and less postoperative pain, while structural iliac bone grafts provided better long-term maintenance of spinal alignment and stability, suggesting their use in cases where long-term outcomes are critical.

Keywords: Autogenous bone grafts; Spinal tuberculosis; Surgery; Thoracic and thoracolumbar.

Fig. 1

A 53-year-old woman with T9–10 tuberculosis. A, B The X-ray film before surgery demonstrated intervertebral stenosis between the T9–10. C–F Preoperative CT and MRI showed T9–10 vertebral bone destruction with paravertebral and intraspinal abscess. G–J Postoperative X-ray and CT of the patient who underwent anterolateral debridement and instrumentation at T9–10 with autologous rib bone graft. K–N X-ray and CT at 24 months postoperative showed good bone fusion between T9–10, without signs of tuberculosis recurrence and no apparent bone absorption or fractures

Fig. 2

A 45-year-old woman with T11–12 tuberculosis. A, B Preoperative X-ray before surgery demonstrated vertebral bone destruction and kyphosis at T11–12. C–F Preoperative CT and MRI showed T11–12 vertebral bone destruction with paravertebral and intraspinal abscess. G–J Postoperative X-ray and CT of the patient underwent anterolateral debridement and instrumentation at T11–12 with autologous structural iliac bone graft. K–N X-ray and CT at 25 months postoperative showed good bone fusion and spinal alignment without signs of tuberculosis recurrence and hardware failure