Comparison of three different bone graft methods for single segment lumbar tuberculosis: A retrospective single-center cohort study

Objective: To compare the clinical efficacy of one stage posterior debridement with iliac bone graft, titanium mesh bone graft or granular bone graft in the surgical treatment of single segment lumbar tuberculosis. Methods: Ninety-eight patients who underwent one stage posterior debridement, bone graft and internal fixation for single segment lumbar tuberculosis from 2015 to 2018 were involved in this study, involving 32 case in iliac bone graft group, 32 case in titanium mesh bone graft group and 34 cases in granular bone graft group. The primary outcomes involved operative time, operative blood loss, postoperative hospital stay, visual analogue scale (VAS) score, erythrocyte sedimentation rate (ESR), C reactive protein (CRP), ASIA grade and postoperative complications. The secondary outcomes were Cobb angle correction and loss, and bone graft fusion time. All the outcomes were recorded and analyzed. Results: Compared with iliac bone graft and titanium mesh bone graft group, granular bone graft had shorter operative time (P = 0.003), less operative blood loss (P = 0.010) and shorter bone graft fusion time (P < 0.001). With the follow-up of 14-36 months, the VAS score, ESR, CRP and neurological function in the three groups were all significantly improved (P < 0.05). The bone graft fusion time of the granular bone graft group was significantly shorter than iliac bone graft group and titanium mesh bone graft (P < 0.05), but no significant differences were found in the correction and loss of Cobb angle, and the incidence of complications among the three groups (n.s.). Conclusion: Granular bone graft has less surgical trauma and shorter bone graft fusion time compared with iliac bone graft and titanium mesh bone graft in the surgical treatment of single segment lumbar tuberculosis. The three methods may achieve comparable clinical efficacy in alleviating symptoms, correcting kyphosis and improving neurological function for appropriate cases.