Abstract:

Objective: To investigate the clinical effectiveness of individualized 3D printed artificial vertebrae in vertebral reconstruction of tuberculosis-affected spine. Methods: From May 2021 to May 2023, 208 patients with spinal tuberculosis were treated in Department of Orthopedics of the Third People’s Hospital of Kunming City, among whom 15 were treated with debridement surgery and individualized 3D printed artificial vertebral reconstruction. The patients included 5 males and 10 females, aged from 31 to 72 years old (45.1±13.2) years. Lesions located at thoracic vertebra for 2 cases, at thoracolumbar spine for 2 cases, at lumbar spine for 1 case and at lumbosacral spine for 10 cases. Lesions affected 2 vertebrae in 6 cases, and more than 3 vertebrae in 9 cases. Postoperative stability of artificial vertebral body, bone ingrowth of adjacent vertebral body, preoperative and postoperative neurological changes, visual analogue scale (VAS) scores, deformity correction, and recurrence of tuberculosis were observed and analyzed. Results: All 15 patients successfully completed the operation without serious vascular and neurological complications. Among them, there were 8 cases taking anterior surgery approach, 2 cases taking posterior approach and 5 cases taking combined posterior and anterior approach. The average operative time was (292.2±119.0) min, and the average intraoperative blood loss was (553.3±333.5) ml. Compared with the preoperative VAS score (5.7±0.9), average VAS scores at 7 d postoperative and at last follow up (2.9±0.5 and 1.8±0.5) declined significantly (t=9.599, P<0.001; t=13.752, P<0.001). At 1 month after surgery, one case with preoperative Frankel grade A gradually recovered to grade D, 2 cases with preoperative Frankel grade B recovered to grade D, and 1 case with Frankel grade B recovered to grade C. In 2 patients underwent kyphosis correction during surgery, no loosening and displacement of the artificial vertebrae and no failure of internal fixation were observed during the follow-up. All 15 patients had no tuberculosis recurrence during follow-up. Conclusion: The short-term effectiveness of individualized 3D printed artificial vertebral body in the reconstruction of tuberculosis-affected spine is relatively good, while the fusion of artificial vertebral bodies needs to be further observed and studied.

Key words: Tuberculosis, spinal, Bone remodeling, Treatment outcome