Combined posterior-anterior surgery with autologous bone grafting for multi-segmental spinal tuberculosis

Multi-segmental spinal tuberculosis is a severe infectious disease of the spine affecting multiple vertebral bodies, often leading to spinal instability, progressive kyphosis, and irreversible neurological impairment. Its diagnosis and treatment are notably challenging due to the extensive distribution of lesions and severe bone destruction.

A retrospective analysis was conducted on 95 patients with multi-segmental spinal tuberculosis involving four or more vertebrae, who were treated at the Department of Orthopedics, General Hospital of Ningxia Medical University, from January 2001 to December 2024. All patients underwent a combined surgical strategy of posterior long-segment pedicle screw fixation followed by anterior radical debridement, decompression, and autologous iliac crest structural bone grafting. Clinical efficacy was systematically evaluated by assessing preoperative and postoperative indicators, including Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), Cobb angle, Visual analog Scale (VAS) for pain, and Oswestry Disability Index (ODI).

At 6 months postoperatively, ESR and CRP levels approached normal values and were within the normal range at the final follow-up. The correction rate of the Cobb angle was 48.32% ± 16.77%, with a mean loss of correction of only 4.85° ± 3.27°. The bone graft fusion rate exceeded 90% at 6 months and 95% at 1 year, with an average fusion time of 4.5 months. At the final follow-up, successful bone fusion was achieved in all patients, with 89 cases (93.7%) achieving Bridwell Grade I fusion and 6 cases (6.3%) achieving Bridwell Grade II fusion. VAS pain scores and ODI scores were significantly lower at 6 months post-surgery compared to preoperative values and continued to decrease thereafter. Neurological function showed significant improvement. No severe neurological complications were observed. Only two patients experienced wound complications and four had transient hepatic or renal dysfunction, all of whom recovered after conservative or minimally invasive treatment.

The combined surgical approach of posterior long-segment internal fixation with anterior debridement and intervertebral autologous strut bone grafting is effective in controlling infection, correcting kyphosis, reconstructing spinal stability, and promoting neurological recovery in patients with multi-segmental spinal tuberculosis. The incidence of perioperative complications is low and manageable. Given the single-center, retrospective design of this study, further multi-center, prospective, randomized controlled trials are needed to validate its safety and long-term efficacy.