Application of multi-pore 3D printed artificial vertebral body in spinal tuberculosis vertebral reconstruction

English Keywords:Spinal tuberculosis  3D printed  Interbody fusion  Musculoskeletal tuberculosis  Spinal infectious disease

English Abstract:

  【Abstract】 Objectives: To study the clinical outcomes of 3D printed artificial vertebrae in vertebral reconstruction of spinal tuberculosis. Methods: From May 2018 to June 2021, 36 patients with spinal tuberculosis were treated surgically in our department. Among them, 10 cases were treated with debridement surgery and 3D printed artificial vertebral reconstruction, including 3 cases of custom-made prosthesis and 7 cases of non-custom prosthesis. There were 4 males and 6 females, aged 26-73 years, with a median age of 59 years. Tuberculosis affected cervical spine in 1 case, thoracic spine in 4 cases, thoracolumbar spine in 2 cases, lumbar spine in 1 case, and lumbosacral spine in 2 cases. Three adjacent vertebrae were involved in 2 cases, two adjacent vertebral bodies were involved in 8 cases. All patients received anti-tuberculosis chemotherapy for 2 weeks before operation. The extent of excision was planned according to the size of lesions. The contact surface and fixation mode of prosthesis with bone were customized for individuals. Postoperative oral anti-tuberculosis drugs were given for 12-18 months. ESR, blood routine test, liver and kidney function and VAS were followed monthly. Postoperative imaging, VAS pain scales, Frankel neurological function, fusion of prosthesis, daily activity function were regularly followed. Results: All patients were followed up for 12-45 months(mean 20.1±9.1 months). The kyphosis angle of operative segment improved to -8°-32° at final follow-up from -24°-24° before operation, which improved 0-32°. The preoperative VAS pain score was 6.4±2.6, and that at the final follow-up was 2.0±1.8. Frankel classification of spinal cord function at final follow-up: 8 cases improved at least 1 grade; 2 cases remained stable; Except 1 case of drug resistant tuberculosis, positions of all the other prosthesis were stable without loosening, subsidence or displacement. Bridwell interbody fusion grading system: grade Ⅰ, 2 cases; grade Ⅱ, 5 cases; and grade Ⅲ, 3 cases. Interface fusion evaluated by CT: complete fusion in 1 case, preliminary fusion in 4 cases, delayed fusion in 4 cases, 1 case of nonfusion. Conclusions: The 3D printed artificial vertebrae have the features of individualized, good immediate stability and fewer fusion segments in spinal tuberculosis. Its short-term clinical effect is definite, while the prosthesis fusion condition needs long-term follow-up.