Jiandang Shi1, Zili Wang, Pei Wang, Weidong Jin. 1. Department of Orthopaedics, the General Hospital of Tianjin Medical University, Tianjin 300052, PR China. shi_jiandang@163.com
Abstract
OBJECTIVE: To evaluate the clinical results of allogeneic bone graft for interbody fusion in cervical tuberculosis. METHODS: Between January 2000 and January 2008, 30 cases of cervical tuberculosis were treated with allogeneic (group A, n = 15) or autologous (group B, n = 15) iliac crest bone graft combined with anterior fixation after radical debridement. In group A, there were 8 males and 7 females with an average age of 38 years; the disease duration was 6 to 14 months; the preoperative kyphosis Cobb angle was (8.6 +/- 11.3) degrees; the preoperative Japanese Orthopaedic Association (JOA) score was 13.0 +/- 3.1 for neurological function; and the length of bone graft was 32 mm on average. In group B, there were 9 males and 6 females with an average age of 42 years; the disease duration was 4 to 17 months; the preoperative kyphosis Cobb angle was (4.9 +/- 7.4) degrees; the preoperative JOA score 12.3 +/- 4.2; and the length of bone graft was 34 mm on average. There was no significant difference in general data between 2 groups (P > 0.05). RESULTS: The operation time and bleeding volume in group A were significantly less than those in group B (P < 0.05). Wound effusion were found in 2 cases of group A, and the other incisions healed by first intention. No infection occurred in group B. In group A, 13 cases were followed up 12-48 months; in group B, 14 cases were followed up 13-46 months. The time of bone graft healing in group A [(7.6 +/- 2.1) months] was significantly longer than that in group B [(4.2 +/- 1.1) months] (t = 2.773, P = 0.005). The kyphosis Cobb angles were significantly improved at 6 months and last follow-up after operation in 2 groups when compared with that before operation (P < 0.05), but no significant difference was found between 2 groups at different time after operation (P > 0.05). There was no significant difference in JOA score at 6 months after operation between group A (14.1 +/- 2.6) and group B (14.3 +/- 2.4) (t = 1.655, P = 0.162). The improvement rate for neural function were 83.7% in group A and 87.8% in group B, showing no significant difference (chi2 = 3.150, P = 0.071). There was no loosening of internal fixation and recurrence of tuberculosis in 2 groups during follow-up. Five cases had chronic pain at iliac donor sites in group B. According to Bridewell et al. evaluation standard, the bone fusion was satisfactory in 11 cases (84.6%) and unsatisfactory in 2 cases (15.4%) in group A, and was satisfactory for all in 14 cases (100%) in group B. The satisfactory rate of bone fusion showed no significant difference between 2 groups (chi2 = 2.680, P = 0.115). CONCLUSION: Allogeneic bone grafting has a good clinical result for spinal fusion in cervical tuberculosis surgery, which can treat tuberculosis bone defect effectively.
OBJECTIVE: To evaluate the clinical results of allogeneic bone graft for interbody fusion in cervical tuberculosis. METHODS: Between January 2000 and January 2008, 30 cases of cervical tuberculosis were treated with allogeneic (group A, n = 15) or autologous (group B, n = 15) iliac crest bone graft combined with anterior fixation after radical debridement. In group A, there were 8 males and 7 females with an average age of 38 years; the disease duration was 6 to 14 months; the preoperative kyphosis Cobb angle was (8.6 +/- 11.3) degrees; the preoperative Japanese Orthopaedic Association (JOA) score was 13.0 +/- 3.1 for neurological function; and the length of bone graft was 32 mm on average. In group B, there were 9 males and 6 females with an average age of 42 years; the disease duration was 4 to 17 months; the preoperative kyphosis Cobb angle was (4.9 +/- 7.4) degrees; the preoperative JOA score 12.3 +/- 4.2; and the length of bone graft was 34 mm on average. There was no significant difference in general data between 2 groups (P > 0.05). RESULTS: The operation time and bleeding volume in group A were significantly less than those in group B (P < 0.05). Wound effusion were found in 2 cases of group A, and the other incisions healed by first intention. No infection occurred in group B. In group A, 13 cases were followed up 12-48 months; in group B, 14 cases were followed up 13-46 months. The time of bone graft healing in group A [(7.6 +/- 2.1) months] was significantly longer than that in group B [(4.2 +/- 1.1) months] (t = 2.773, P = 0.005). The kyphosis Cobb angles were significantly improved at 6 months and last follow-up after operation in 2 groups when compared with that before operation (P < 0.05), but no significant difference was found between 2 groups at different time after operation (P > 0.05). There was no significant difference in JOA score at 6 months after operation between group A (14.1 +/- 2.6) and group B (14.3 +/- 2.4) (t = 1.655, P = 0.162). The improvement rate for neural function were 83.7% in group A and 87.8% in group B, showing no significant difference (chi2 = 3.150, P = 0.071). There was no loosening of internal fixation and recurrence of tuberculosis in 2 groups during follow-up. Five cases had chronic pain at iliac donor sites in group B. According to Bridewell et al. evaluation standard, the bone fusion was satisfactory in 11 cases (84.6%) and unsatisfactory in 2 cases (15.4%) in group A, and was satisfactory for all in 14 cases (100%) in group B. The satisfactory rate of bone fusion showed no significant difference between 2 groups (chi2 = 2.680, P = 0.115). CONCLUSION: Allogeneic bone grafting has a good clinical result for spinal fusion in cervical tuberculosis surgery, which can treat tuberculosis bone defect effectively.