Analyzing The Clinical Effect Of One-stage Anterior Debridement With Iliac Crest Allograft Or Autograft In The Treatment Of Thoracolumbar Tuberculosis

Objective: To evaluate the feasibility, reliability and validity of single-stage anterior debridement with iliac crest allograft or autograft combined with internal fixation for the treatment of thoracolumbar tuberculosis. Method: From January 2012 to June 2014, 107 cases of thoracolumbar tuberculosis were treated with allogeneic or autologous iliac crest graft combined with internal fixation after radical debridement, which were reviewed retrospectively. These cases were divided into two groups: 71 cases in allogenic iliac crest grafts operation group(group A), and 36 cases in iliac crest autografts operation group(group B).In group A, their average age was 42.5 years(2 to 80years).In group B, their average age was 40.3 years(14 to 68years). The pre-and postoperative clinical data, surgical data, imaging data and the data of final follow-up were collected. The operation time, bleeding volume, hospital stay, VAS scores, JOA scores, ESR and CRP level, graft fusion rate and the changes of ASIA scale in two groups were evaluated respectively before and after surgery. Result: The operation time in group A were significantly less than those in group B(P<0.05). The average hospital stays and bleeding volume were no significant difference between two groups(P>0.05). In each group, VAS scores, JOA scores, ESR and CRP level and the changes of ASIA scale were significant difference between pre-operation and post-operation(P<0.05), but these index showed that no significant difference between the two groups(P>0. 05). Compared with group A, the average ESR level in group B was less at 3 months after the operation(P< 0.05). At final follow-up, the graft fusion rate and the changes of ASIA showed no significant difference between two groups(P>0.05). Perioperative complications consisted of gastrointestinal dysfunction in 5 cases(group A, 3cases; group B, 2cases), and pulmonary infection in 6 cases(group A, 4cases; group B, 2cases). Postoperative complications included kyphosis in 4 cases(group A, 3cases; group B, 1cases), tuberculosis recurrence in 5 cases(group A, 3cases; group B, 2cases), sinus formation in 3 cases(group A, 2cases; group B, 1cases), chronic pain of the donor site in 6 cases(group B). Conclusion: Allogeneic iliac crest has the characteristics of good biological safety and biomechanical strength. It is safe and feasible to carry out anterior allogeneic iliac crest bone graft combined with internal fixation after radical debridement in patients with spinal tuberculosis on the basis of systemic anti-tuberculosis.