Titanium Mesh Cage for Anterior Stabilization in Tuberculous Spondylitis : Is It Safe?.

Bak, Koang Hum; Cheong, Jin Hwan; Kim, Jae Min; Kim, Choong Hyun; Kim, Seung Bum

Original Article

Journal of Korean Neurosurgical Society 2006;40(6): 412-418.

Koang Hum Bak, Jin Hwan Cheong, Jae Min Kim, Choong Hyun Kim, Seung Bum Kim

¹Department of Neurosurgery, School of Medicine, Hanyang University, Seoul, Korea. pkh2325@hanyang.ac.kr
²Department of Neurosurgery, School of Medicine, Kyung Hee University, Seoul, Korea.

ABSTRACT

OBJECTIVE
The safety of titanium metal cages in tuberculous spondylitis has not been investigated. We evaluated the outcome and complications of titanium mesh cages for reconstruction after thoracolumbar vertebrectomy in the tuberculous spondylitis.
METHODS
There were 17 patients with 18 operations on the tuberculous spondylitis in this study. Sixteen patients were operated with anterior corpectomy and reconstruction with titanium mesh cage followed by posterior transpedicular screw fixations on same day, two pateints were operated by either anterior or posterior approach only. After the affected vertebral body resection and pus drainage from the psoas muscle, titanium mesh cage, filled with morselized autogenous bone, was inserted. All the patients had antituberculosis medication for 18 months. The degree of kyphosis correction and the subsidence of cage were measured in the 15 patients available at a minimum of 2 years. Outcome was assessed with various cross-sectional outcome measures. Recurrent infection was identified by serial ESR(Erythrocyte Sedimentation Rate) and CRP(Cross Reactive Protein) .
RESULTS
There was no complication from the use of a titanium mesh cage. Recurrent infection was not detected in any case. Average preoperative of 9.2degrees was reduced to -2degrees at immediate postoperative period, and on final follow up period kyphotic angle was measured to be 4.5degrees. Postoperatively, subsidence was detected in most patients especially at ambulation period, however further subsidence was prevented by the titanium mesh cage. Osseous union was identified in all cases at the final follow-up.
CONCLUSION
The cylindrical mesh cage is a successful instrument in restoring and maintaining sagittal plane alignment without infection recurrence after vertebrectomy for tuberculous spondylitis.

Key Words: Spondylitis; Tuberculosis; Surgical mesh; Vertebrectomy; Reconstruction