[The autologous bundled multi-segment rib graft reconstruction for bone defects after thoracic spinal tuberculosis debridement].

Objective: To investigate the effectiveness of bundled multi-segment autologous rib graft reconstruction for bone defects after thoracic spinal tuberculosis debridement.

Methods: The anterior debridement, multi-segment autologous rib interbody fusion, anterior or posterior internal fixation were used for treating the bone defect after thoracic spinal tuberculosis debridement in 36 cases between January 2006 and December 2013. There were 20 males and 16 females with an average age of 50.5 years (range, 21-60 years), and an average disease duration of 6.8 months (range, 5-11 months). The thoracic vertebral tuberculosis located at T in 1 case, T in 4 cases, T in 4 cases, T in 4 cases, T in 9 cases, T in 8 cases, T in 5 cases, and T in 1 case. Neurological impairment of 34 patients was assessed as grade B in 2 cases, grade C in 8 cases, and grade D in 24 cases according to Frankel classification. The pre- and post-operative erythrocyte sedimentation rate (ESR), C reactive protein (CRP), visual analogue scale (VAS) score, and kyphosis Cobb angle were evaluated. The fusion rate was analysed based on CT three-dimensional reconstruction.

Results: The cross-sectional area of the bundled multi-segment rib graft was 136.8-231.2 mm (mean, 197.1 mm ); the endplate surface area of adjacent upper and lower vertebral bodies was 425.0-677.6 mm (mean, 550.6 mm ); and the cross-sectional area of rib graft accounted for 29%-50% (mean, 33.6%) of the endplate surface area. The operation time was 95-160 minutes (mean, 125 minutes) and the intraopeartive blood loss was 280-850 mL (mean, 450 mL). All the patients were followed up 2-8 years (mean, 4.4 years). The postoperative complications included intercostals neuralgia in 2 cases, pleural effusion in 1 case, and liver function damage caused by antituberculosis drugs in 2 cases, who were all cured after symptomatic treatment. The rest patients had no respiratory complications and wound infection; and there was no fracture, displacement, absorption of rib support, tuberculosis recurrence, internal fixation loosening, and kyphosis occurred in all patients. CT three-dimensional reconstruction showed that the fusion rate was 86.1 (31/36) at 6 months after operation and was 97.2% (35/36) at 12 months after operation. The ESR, CRP, VAS scores, and kyphosis Cobb angle at 3 months after operation and last follow-up were significantly improved when compared with preoperative values ( <0.05), but there was no significant difference between at 3 months after operation and last follow-up ( >0.05). Neurological deficits were all improved at last follow-up according to Frankel classificaiton, including 2 cases with grade B recovered to grade D, 8 cases with grade C to grade D in 1 case and to grade E in 7 cases, 24 cases with grade D all to grade E.

Conclusion: Bundled multi-segment autologous rib graft reconstruction is an alternative method for less than 2 discs and vertebral bone defect created by radical debridement for thoracic spinal tuberculosis.