Discussion Of Issues Related To Titanium Mesh In Posterior Spinal Reconstruction For Thoracolumbar Tuberculosis Surgery

Purpose:Exploring the role of titanium mesh in posterior spinal reconstruction for thoracolumbar tuberculosis and the recovery of spinal compliance and neurological function before and after surgery.Materials and methods:A total of 107 patients who were clearly diagnosed with thoracic or lumbar spine tuberculosis and treated with reconstructive surgery with titanium mesh implantation in the posterior approach between 01/2012 and12/2020 were selected.There were 55 males（51.4%）and 52 females（48.6%）with a mean age of 55.76±14.52 years.The number of involved segments was one in 47 cases,accounting for 43.9%;the number of involved segments was two in 42 cases,accounting for 39.3%;the number of involved segments was greater than or equal to three in 18 cases,accounting for 16.8%.Statistical analysis of posterior lesion removal,trans-titanium mesh bone grafting and spinal reconstruction of thoracolumbar tuberculosis: 1.pre-and post-operative spinal alignmentsagittal and coronal Cobb angle correction;2.post-operative neurological recovery;3.VAS score and Kirkaldy-Willis functional score;4.comparison of titanium mesh endografting with different bone grafting sources.Result:1.Pre-operative and post-operative spinal alignment: 96 of 107 patients with thoracolumbar spinal tuberculosis showed significant Cobb angle changes in the sagittal plane.Among the 107 patients with thoracolumbar spinal tuberculosis,23 patients showed significant changes in the Cobb angle in the coronal plane,with a preoperative Cobb angle of17.68±8.02 degrees and a postoperative Cobb angle of 4.66±4.43 degrees,with a significant difference in the preoperative and postoperative Cobb angles（P<0.05）.There was a significant difference between the preoperative and postoperative coronal Cobb angles（P < 0.05）,and the lateral convexity deformity was significantly improved in these patients after surgery.2.Postoperative neurological recovery: there were 71 cases of neurological dysfunction in 107 patients with thoracolumbar spinal tuberculosis,according to ASIA classification: 0 cases of grade A;5 cases of grade B,of which 2 cases recovered to grade C and 3 cases recovered to grade D;23 cases of grade C,11 cases recovered to grade D,8 cases recovered to grade E and 4 cases did not recover;43 cases of grade D,38 cases recovered to grade E and 5 cases did not recover;36 cases recovered to grade E;63 cases recovered neurological function after surgery（P <0.05）.The neurological function was restored in 63 cases,and the neurological function of patients with preoperative neurological dysfunction was significantly improved after surgery（P < 0.05）.3.VAS score and Kirkaldy-Willis functional score: The results of the comparison of VAS scores before and after surgery: 107 patients with thoracolumbar spinal tuberculosis had different degrees of back pain before surgery,and the VAS score was 6.61±1.14,and the VAS score after surgery was 2.33±0.83.There was a significant difference between the two（P<0.05）,and the patients had significant pain relief after surgery.By counting the Kirkaldy-Willis functional scores,the patients were rated as excellent 71,good 25,acceptable 9,and poor 2 at the last follow-up,with an excellent rate of 89.72%.4.Comparison of titanium mesh endograft with different bone graft sources: Among the 42 patients screened with two-segment involvement of thoracolumbar tuberculosis,there were 14 cases in which the titanium mesh endograft was mixed with autograft bone,and 12 cases in which the titanium mesh endograft was completely autograft bone,and the average time of bone graft fusion was 8.14±1.17 months in the mixed autograft bone group and 7.08±1.31 months in the autograft bone group.There was a significant difference between the two groups（P < 0.05）,and the autologous bone group had less time to fusion than the mixed autograft bone group.Conclusion:1.Titanium mesh can play a role in supporting,maintaining corrective orthopedics,stabilizing localization and ensuring bone graft fusion in posterior spinal reconstruction for thoracolumbar tuberculosis.2.For posterior surgical spinal reconstruction of thoracolumbar tuberculosis with more involved segments,the titanium mesh endograft source can increase the proportion of autologous bone to obtain better fusion results.3.The stability of the spine has a positive effect on the recovery of neurological function and implant fusion,thus helping to improve the quality of life of patients with thoracolumbar spinal tuberculosis.