Clinical Outcomes of Posterior Surgery with Autologous Lamina Spinous Process Bone and Nanohydroxyapatite/Polyamide-66 for Single-Segment Lumbar Tuberculosis

Clinical Outcomes of Posterior Surgery with Autologous Lamina Spinous Process Bone and Nanohydroxyapatite/Polyamide-66 for Single-Segment Lumbar Tuberculosis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Outcomes of Posterior Surgery with Autologous Lamina Spinous Process Bone and Nanohydroxyapatite/Polyamide-66 for Single-Segment Lumbar Tuberculosis Yanghui Jin, Zhongqiang Wang, Fei Liu, Xiaozhang Ying, Qi Zheng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8522383/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To evaluate the key techniques and benefits of autologous lamina spinous process (LSP) bone with nanohydroxyapatite/polyamide-66 (n-HA/PA66) in single-segment lumbar tuberculosis posterior surgery Methods This retrospective study analyzed 39 patients with single-segment lumbar tuberculosis. They were treated at our department from January 2018 to December 2023. Based on the graft material, patients were assigned to one of two groups: Group A (n = 19) received a composite bone graft (LSP + n-HA/PA66), while Group B (n = 20) underwent a traditional autologous iliac bone graft. Surgical parameters, including operative time and blood loss. Clinical outcomes were assessed using the visual analogue scale (VAS) and Oswestry Disability Index (ODI). Inflammatory markers were evaluated with erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Neurological status was graded with the American Spinal Injury Association (ASIA) grade. Radiographic investigation involved measuring the Cobb angle at three time points and checking if the bones had fused. Results All patients were followed up for an average of 19.59 ± 1.53 months. Group A had a shorter surgery time and less blood loss during surgery. These differences were statistically significant. (P < 0.05). Both groups exhibited significant postoperative improvements in ESR, CRP, ODI, and VAS scores at all time points compared to their preoperative baselines (P 0.05). All patients achieved bone fusion. However, Group A needed more time to reach fusion than Group B. This difference was statistically significant (P < 0.05). Regarding complications, one elderly patient in Group A developed muscular venous thrombosis in the right lower limb. In Group B, five patients (25%) experienced persistent pain at the iliac crest graft site. The incidence of donor site pain was significantly higher in Group B (P < 0.05). Conclusions For single-segment lumbar tuberculosis, a composite bone graft (LSP + n-HA/PA66) represents a promising grafting method. Compared to traditional autologous iliac bone, this composite graft reduces operative time and blood loss while eliminating donor site morbidity. Autologous lamina spinous process Lumbar tuberculosis bone graft Surgery Figures Figure 1 Figure 2 Figure 3 Background The 2024 World Health Organization (WHO) Global Tuberculosis Report shows that tuberculosis is now the top cause of death from a single infectious disease worldwide [ 1 ]. Spinal tuberculosis (STB) is the most common type found outside the lungs, and it usually affects the lower back. This disease can break down the spinal bones, collapse the space between them, and cause a hunched-back deformity [ 2 ]. Surgery and anti-tuberculosis drugs are a key way to treat it. The anterior-posterior method is a traditional and good way to fix lumbar tuberculosis because it uses both front and back methods. But it causes a lot of tissue damage, major blood loss, and has higher risks [ 3 ]. Therefore, the posterior-only approach has become a common and effective surgery over the past ten years [ 3 – 5 ]. After debridement, surgeons use various materials for spinal support, such as autologous iliac bone, titanium mesh, and allograft, which are often effective [ 6 – 7 ]. However, these methods carry risks, including chronic donor site pain, hematoma, non-union, and mesh subsidence. LSP offers advantages like excellent biocompatibility, robust osteogenic capacity, ease of shaping, and structural support [ 8 ]. But it is not as strong or stable as autologous iliac crest bone. So, this study compared these two materials. One method used a composite bone graft (LSP + n-HA/PA66). The other used autologous iliac bone. We looked at patient recovery and radiographic results. We wanted to see if the new method works for lumbar tuberculosis bone defects. Our goal was to check if LSP with n-HA/PA66 can be a good choice for surgery. Materials and methods Patient selection Inclusion criteria: (1) aged over 18 years, with confirmed STB in the lumbar spine (L1–S1); (2) only one segment was involved, or multiple segments were affected, but only one required surgery; (3) presence of spinal neurological impairment or paravertebral abscess limited to affected vertebrae; (4) spinal instability or deformity with progressive worsening tendency; Exclusion criteria: (1) history of lumbar surgery or congenital spinal deformity potentially interfering with postoperative assessment; (2) multilevel lesions needing surgical intervention; (3) extensive surrounding abscess with distant tracking unsuitable for posterior surgical clearance; (4) significant psychiatric disorders with poor medication compliance; (5) active TB or other contraindications, including severe coagulation disorders. Study Cohort: The study included 39 patients with lumbar tuberculosis. These patients met all selection criteria. They were treated between January 2018 and December 2023. All patients underwent a posterior-only surgical approach consisting of lesion debridement, pedicle screw instrumentation, and interbody fusion. Patients were divided into two groups based on the bone graft they received. Group A (19 patients) was grafted with a composite bone graft, and Group B (20 patients) received autologous iliac bone. Most patients came to the hospital with low back pain. Many also had pain going down their legs. Some felt numbness in their legs. The severity of these symptoms varied among patients. X-ray and computed tomography (CT) demonstrated varying degrees of narrowing in the affected intervertebral spaces, accompanied by bone destruction in the adjacent vertebral bodies. Magnetic resonance imaging (MRI) findings revealed edema in the involved vertebral bodies, along with the formation of intervertebral or epidural abscesses. All patients had high ESR and CRP levels. These are blood tests that show inflammation. The two groups were similar in their basic characteristics before treatment. This similarity makes them suitable for comparison. The details are shown in Table 1 . Table 1 General data of two groups. Group A (n = 19) Group B (n = 20) Statistical value P-value Sex (M/F) 10/9 12/8 χ 2 = 2.309 0.191 Age (Y) 65.05 ± 12.77 63.20 ± 10.71 t = 0.492 0.626 Disease course (months) 6.53 ± 3.22 6.35 ± 2.91 t = 0.180 0.858 Preoperative ESR (mm/1h) 45.95 ± 22.74 50.85 ± 21.91 t=-0.686 0.497 Preoperative CRP (mg/L) 35.47 ± 24.38 36.15 ± 17.05 t=-0.101 0.920 Preoperative VAS 6.26 ± 1.24 6.60 ± 0.82 t=-1.005 0.321 Preoperative ODI 40.00 ± 1.53 40.95 ± 4.33 t=-0.903 0.372 Preoperative Cobb angle (°) 14.89 ± 3.46 15.30 ± 4.81 t=-0.300 0.766 Preoperative ASIA (A/B/C/D/E) 0/0/2/8/9 0/0/3/9/8 Z=-0.169 0.866 n: number of patients. M: male; F: female; Y: years; ODI: Oswestry Disability Index; VAS: visual analogue scale; ASIA: American Spinal Injury Association. Preoperative management All patients received a conventional quadruple anti-tuberculosis regimen (isoniazid 0.3 g, rifampicin 0.45 g, ethambutol 0.75 g, and pyrazinamide 1.5 g, administered orally in a single dose before breakfast) for 2–4 weeks preoperatively. Measures were actively taken to correct hypoalbuminemia and anemia, along with enhanced systemic nutritional support. After systemic conditions improved and ESR and CRP stabilized or began to decline, patients underwent surgery. Surgical management All patients underwent general endotracheal anesthesia and were positioned prone after successful anesthesia induction. In Group A, a posterior midline incision was made centered on the affected vertebra under C-arm fluoroscopic guidance. Subperiosteal dissection of the paraspinal muscles exposed the posterior elements of the pathological vertebra and 1–2 adjacent healthy vertebrae, followed by pedicle screw insertion. The entire LSP was cut off using an ultrasonic osteotome and carefully removed en bloc (Fig. 1A). And after meticulous removal of the attached soft tissues (Fig. 1B), it was preserved in aseptic moist gauze for subsequent grafting. Subsequently, the facet joint on the more severely affected side of the pathological intervertebral space was resected. A lamina spreader was applied on the contralateral side to restore intervertebral height, followed by placement of a temporary connecting rod to prevent spinal cord injury resulting from segmental displacement. Vertebrectomy, including removal of the intervertebral disks, was performed using a combination of a bone chisel and an ultrasonic osteotome. Moreover, a range of curette sizes were used to achieve full debridement. The lesion area and surrounding abscess were irrigated with hydrogen peroxide and normal saline, and the bony surfaces of the residual vertebrae at the defect margins were prepared. Previously obtained LSP was trimmed to size with an ultrasonic bone scalpel (Fig. 1C), and the remaining bone was morselized for subsequent packing into the n-HA/PA66 (Fig. 1D, E). This composite graft was then implanted to achieve supported fusion in the bone defect area. After meticulous hemostasis and satisfactory neural decompression were achieved, C-arm fluoroscopy confirmed satisfactory positioning of the internal fixation and bone graft. Subsequently, 2–4 g of streptomycin was applied locally. The surgical area was sealed with gelatin sponge, two negative pressure drainage tubes were placed, and layered wound closure was performed. Intraoperatively collected pus and intervertebral disc tissue specimens were sent for Mycobacterium tuberculosis culture and pathological examination. For Group B, the surgery involved two main stages. First, pedicle screws were inserted as in Group A, but without posterior decompression. Next, an anterior approach was performed. With the patient in the lateral position, an oblique abdominal incision was made. The abdominal muscle layers were separated to access the retroperitoneal space. After protecting the peritoneal contents, the psoas muscle was separated to expose the vertebral body for lesion clearance and decompression. The bone defect was measured and protected with saline-soaked gauze. A separate incision was then made along the anterior superior iliac spine to harvest a tricortical bone graft, which was trimmed to fit the defect. Finally, a drain was placed, and the incision was closed in layers. Figure 1 The steps for preparing the autologous LSP were as follows. A The autologous LSP for interbody fusion was obtained in the operation area. B The soft tissues on the surface of the LSP were meticulously removed before grafting. C The LSP was trimmed to size with an ultrasonic bone scalpel. D, E The remaining bone was morselized for subsequent packing into the n-HA/PA66 Postoperative care Both drainage tubes were maintained for 3–5 days postoperatively and removed when the daily output fell below 30 ml. Lumbar spine X-ray and CT scans were performed after drain removal. Patients were permitted to ambulate with brace protection one week postoperatively and were required to wear the brace for at least three months. Antituberculosis chemotherapy was continued for 18 months, with timely regimen adjustments in cases of adverse drug reactions or impaired hepatic/renal function. Follow-up Protocol and Outcome Measures Follow-up Protocol and Outcome Measures Patients were scheduled for monthly assessments of ESR, CRP, and hepatic/renal function. Clinical outpatient follow-ups were conducted at 3, 6, 9, 12, and 18 months postoperatively, with each visit including radiographic evaluations (X-ray, CT, and MRI) of the surgical area. The following outcome measures were employed: (1) Surgical Parameters: Operative time, intraoperative blood loss, and complications. (2) Clinical Outcomes: Pain intensity in the lower back, lower limbs, and iliac graft donor site was assessed using the VAS. Neurological function was evaluated with the ASIA scale, while low back pain-related disability was measured using the ODI [ 9 ]. (3) Radiographic Outcomes: The sagittal Cobb angle at the involved vertebral level and bone fusion time were assessed using the Eck fusion classification criteria [ 10 ]. Statistical analysis All statistical analyses were performed utilizing the SPSS software (version 23.0, Chicago, IL, USA). Data that followed a normal distribution are shown as mean ± standard deviation. We compared differences between groups using t-tests and chi-square tests. We used paired t-tests to compare results before and after treatment in the same group. A P-value less than 0.05 was considered statistically significant. Results Clinical Outcomes The mean follow-up periods were 19.37 ± 1.3 months for Group A and 19.80 ± 1.74 months for Group B, with no statistically significant difference in follow-up times (p = 0.387). Both groups demonstrated statistically significant improvements in ESR, CRP, VAS, ODI, and Cobb angle measurements at all postoperative time points compared to preoperative baseline values (P < 0.05), with these parameters showing continued improvement over time. No statistically significant differences were observed in any of these outcome measures between the two groups at any follow-up interval (P > 0.05, Tables 2 and 3 ). Table 2 Comparisons of clinical results between the two groups. Group A (n = 19) Group B (n = 20) Statistical value P-value Operation time (min) 194.26 ± 25.95 229.75 ± 33.00 t=-3.720 0.001 Blood loss (ml) 309.26 ± 37.80 347.05 ± 50.64 t=-2.630 0.012 Follow-up time (months) 19.37 ± 1.30 19.80 ± 1.74 t=-0.875 0.387 Mean fusion time (months) 8.68 ± 0.48 6.75 ± 0.79 t = 7.138 0.000 Follow-up ASIA (A/B/C/D/E) 0/0/1/3/15 0/0/0/5/15 Z=-0.095 0.924 Kirkaldy-Willis excellence rate (%) 78.94% 80% χ 2 = 0.007 0.935 Complications (%) Cerebrospinal fluid leakage 0(0) 2 (10.5) χ 2 = 2.003 0.157 Ilium bone-harvesting site pain 0(0) 5(25) χ 2 = 5.449 0.020 Deep vein thrombosis 1(5) 0(0) χ 2 = 1.080 0.299 Table 3 Comparison of ESR, CRP, VAS, ODI, and Cobb angle at various postoperative time points between the two groups (X ± S) . Group A (n = 19) Group B (n = 20) Statistical value P-value At 2 weeks postoperative ESR 26.32 ± 4.99 28.60 ± 1.88 t=-1.911 0.064 At 3 months postoperative ESR 17.63 ± 4.23 17.90 ± 4.85 t=-0.184 0.855 Follow-up ESR 10.00 ± 2.42 10.35 ± 2.78 t=-0.418 0.678 At 2 weeks postoperative CRP 25.63 ± 4.35 26.50 ± 4.29 t=-0.628 0.534 At 3 months postoperative CRP 4.53 ± 1.39 5.35 ± 2.48 t=-1.272 0.211 Follow-up CRP 3.89 ± 0.66 3.95 ± 0.76 t=-0.242 0.810 At 2 weeks postoperative VAS 2.95 ± 0.40 3.25 ± 0.64 t=-1.757 0.087 At 3 months postoperative VAS 1.79 ± 0.42 1.65 ± 0.76 t = 0.715 0.479 At 2 weeks postoperative ODI 25.32 ± 2.96 24.75 ± 3.43 t = 0.550 0.586 At 3 months postoperative ODI 9.53 ± 1.98 9.35 ± 1.76 t = 0.294 0.770 At 2 weeks postoperative Cobb angle 9.42 ± 1.89 8.50 ± 1.50 t = 1.686 0.100 Follow-up Cobb angle 10.84 ± 1.70 9.90 ± 2.97 t = 1.205 0.236 However, patients in Group B demonstrated significantly longer operative times and greater intraoperative blood loss (P < 0.05, Table 3 ). With the exception of one patient who maintained their preoperative neurological status at the final follow-up, all patients showed neurological improvement (Table 3 ). Radiological Outcomes Follow-up imaging confirmed all patients achieved clinical recovery. The average bone fusion time was 8.68 months in Group A (Fig. 2) and 6.75 months in Group B (Fig. 3). Group A required significantly more time to achieve bone fusion (p = 0.00). According to the Eck fusion criteria, Grade I fusion was achieved in 15 patients (78.94%) and Grade II in 4 patients (21.06%) in Group A, compared to 16 (80.0%) and 4 (20.0%) patients in Group B, respectively. No significant difference in fusion grade distribution was found between the two groups (P > 0.05; Table 2 ). At the final follow-up, radiographic imaging confirmed successful bone fusion in all patients, with no instances of nonunion, pseudarthrosis, or implant failure. Figure 2A patient with L4-5 spinal tuberculosis obtained a composite bone graft (LSP + n-HA/PA66) for reconstruction. A Preoperative X-rays showed slight narrowing of the L4/5 disc space. B,C Preoperative CT revealed bone destruction in the L4 and L5 vertebrae. D Preoperative MRI showed abscesses anterior and posterior to L4/5 with spinal canal involvement. E Postoperative X-rays (3 days) showed good position of the bone graft and internal fixation. F, G Postoperative CT (9 months) showed basic fusion of the L4/5 graft. H Postoperative MRI (9 months) showed near-complete absorption of the abscesses. Figure 3A patient with L4-5 spinal tuberculosis obtained an autologous iliac bone graft for reconstruction. A preoperative lateral X-ray showed an irregular, worm-eaten L5 upper endplate. B,C Preoperative CT (sagittal) showed bone destruction in L4 and L5. D Preoperative MRI T2 revealed a high signal in the L4/5 disc and adjacent vertebrae, with a posterior abscess compressing the dura. E Lateral X-ray at 2 weeks post-op showed satisfactory fixation and iliac bone graft. F, G Postoperative CT (6 months) showed good bone fusion. H Postoperative MRI (6 months) showed improved vertebral signal and basic absorption of the abscess. Complications Complications in both groups were effectively managed with symptomatic treatment and showed no further progression. In Group A, one elderly patient developed a deep vein thrombosis in the leg. It resolved after blood thinners. In Group B, five patients experienced donor site pain at the iliac crest. Among these, two patients reported persistent pain for more than one month, which was alleviated with continuous non-steroidal anti-inflammatory drug administration. Additionally, two patients in group B had cerebrospinal fluid leaks during surgery. These patients received stronger antibiotics, and no signs of infection were seen during the 3 months after surgery (Table 2 ). Discussion Drug therapy is the main treatment for STB. It works well for most patients. Some patients need surgery. Patients require surgery if they have serious nerve damage, an unstable spine, or a worsening deformity. The primary goals of this surgery are to debride the tuberculosis infection, promote neurological recovery, and restore spinal stability. While the anterior approach is a common technique that provides direct access to debride the lesion and decompress nerves, it has limitations in effectively correcting deformity. There is also a risk of poor bone healing. Because of this, some surgeons opt for a combined anterior and posterior procedure. However, this extensive approach is more traumatic, resulting in increased blood loss, longer surgery duration, and a higher complication rate [ 11 ]. Recently, more surgeons prefer the posterior-only approach because it is less damaging. It allows screw placement above and below the lesion, and the combination of screws with bone grafting stabilizes the spine and corrects deformities [ 12 – 13 ]. But Shi and others have concerns. The posterior approach damages the spine's posterior column and worsens spinal instability. Moreover, as the lesion is removed without direct vision, the debridement may be incomplete. There is also a risk that tuberculosis bacteria could spread to the posterior soft tissues due to positional changes, potentially contaminating the incision and increasing postoperative infection risk [ 10 ]. This study included 19 patients with single-level lumbar tuberculosis. All patients received one-stage posterior surgery. The surgery successfully removed infected tissue. It also placed bone grafts between vertebrae and inserted internal fixation. No patients developed serious problems after surgery. No sinus tracts formed. No surgical site infections occurred. Patients felt much less pain after surgery. No tuberculosis came back at the last check-up. Our experience suggests these points are important during surgery: (1) Remove the facet joint on the worse side. Use a spreader to open the disc space. Tilt the table about 30 degrees away from the operation side. This gives a good view. (2) Fully expose the dura and nerve roots. Protect them with cottonoids and gelatin sponge. This keeps the surgical area clear. (3) Remember that "complete" cleaning is never absolute. Try hard to remove all damaged bone, pus, inflamed tissue, dead disc pieces, and bone fragments from the disc space and surrounding area. Therefore, for patients with one-level lumbar tuberculosis, the posterior-only approach represents a viable surgical strategy that can reduce operative time, surgical trauma, and blood loss, while also contributing to shorter hospital stays and accelerated patient recovery. The Denis three-column theory states that rebuilding the front and middle parts of the spine is important. This helps posterior spine surgery succeed over time. Lumbar tuberculosis often damages these areas. This damage causes spinal instability or deformity. Current reconstruction strategies following debridement for lumbar tuberculosis include autologous iliac bone graft, allograft, titanium mesh cages, and n-HA/PA66 vertebral support. Autologous structural iliac bone graft has been the preferred choice for many years. Studies show this method works in over 90% of cases [ 15 – 16 ]. In our cohort, the mean time of bone fusion was 6.75 ± 0.79 months in group B. However, donor site morbidity remains a major clinical concern, as previous studies have reported complication rates of up to 40%, including pain, nerve injury, hematoma, infection, or fracture [ 17 ]. While no severe complications such as hematoma or infection occurred in our series, five patients in Group B reported significant donor site pain, managed effectively with continuous non-steroidal anti-inflammatory drugs. Additionally, two patients sustained dural tears during graft impaction due to oversized iliac bone blocks, resulting in postoperative cerebrospinal fluid leakage. Recently, several authors have reported utilizing autologous LSP in one-level lumbar tuberculosis or pyogenic spondylodiscitis [ 18 – 20 ]. Zhong et al. [ 18 ] treated 35 patients with single-level thoracic or lumbar tuberculosis using LSP. The average bone healing time was 12.90 ± 3.91 months. In another study on lumbar spinal infections, Tang et al. [ 19 ] observed fusion times of 11.30 ± 4.75 months with LSP versus 6.80 ± 1.50 months with iliac bone graft. These results show that LSP can effectively fill bone defects and maintain spinal stability. This gives surgeons another option for reconstruction. However, using LSP alone has some risks. Bone healing may take longer. In some cases, healing may not occur. Patients may need to wear a spinal brace for a longer time after surgery. In this study, we used a composite bone graft to reconstruct the anterior and middle columns. All patients in this group achieved bone healing. The average healing time was 8.68 ± 0.48 months. The operative time was 194.26 ± 25.95 minutes; this was significantly shorter than Group B. All patients with nerve problems before surgery showed improvement. The healing time in our study was shorter than in reports using LSP alone. We propose that the composite bone graft offers several distinct advantages: (1) Using ultrasonic bone scalpels makes it easy to remove the lamina and spinous process as one solid piece. This technique avoids the need to take bone from the hip. It prevents extra surgical damage and problems related to hip bone removal. (2) The use of en bloc LSP for supportive grafting overcomes the limitations of insufficient mechanical strength when LSP is used merely as morselized bone or as a standalone graft. Combining LSP with n-HA/PA66 gives immediate stability, creates more surface contact, and improves load sharing. These factors help the bones fuse faster. So, for patients with single-level lumbar tuberculosis, this new grafting method is effective. It works best when the bone damage is confined between two pedicles or when the spinal canal has become narrow. The one-stage posterior surgery using the patient's own lamina and spinous process bone provides important benefits: minimal trauma, faster procedures, and no need for iliac bone graft. But this technique is not perfect and has some inherent limitations. The use of this bone is limited by its small size. It is not suitable for severe vertebral lesions or large bone defects, and it cannot be used if the lamina or spinous process is already infected. Furthermore, the LSP + n-HA/PA66 graft has a longer fusion time than iliac bone; it might delay healing and could be a risk factor for slow union. The posterior-only approach also presents inherent limitations in debridement efficacy, particularly in achieving complete clearance of paravertebral cold abscesses with distant tracking. Conclusion Our study found that the LSP combined with the n-HA/PA66 composite serves as a viable alternative to autologous iliac bone graft for single-segment lumbar tuberculosis. This technique concurrently reduces operative time and successfully avoids donor site pain. However, it must be noted that this study is limited by its constrained sample size and relatively insufficient follow-up period. necessitating further investigation through larger, prospective studies to validate these findings. Abbreviations LSP Lamina spinous process n-HA/PA66 nanohydroxyapatite/polyamide-66 VAS Visual analog score ODI Oswestry Disability Index ESR Erythrocyte sedimentation rate CRP C-reactive protein ASIA American Spinal Injury Association WHO World Health Organization CT Computed tomography STB Spinal tuberculosis MRI Magnetic resonance imaging Declarations Ethical approval and consent to participate This study was approved by the ethics committee of Hangzhou Red Cross Hospital (clinical trial number: 2025PT201-001). All methods were performed in accordance with the Declaration of Helsinki and the relevant guidelines and regulations. Informed consent to participate was waived by the ethics committee of Hangzhou Red Cross Hospital due to the retrospective nature of the study design. Consent for publication Not applicable. Competing interests All authors declare no competing interests. Funding Hangzhou Municipal Health Science and Technology Program Project (ZD20250273) Author Contribution YJ and ZW were responsible for the data collation and primary manuscript generation. YJ and FL were responsible for manuscript editing and contributed to data collection. XY and QZ were the senior authors who performed the surgery and contributed to the study design. The author(s) read and approved the final manuscript. Acknowledgements Not applicable. Data Availability The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. References World Health Organization. Global tuberculosis report 2024 [R]. Geneva: World Health Organization; 2024. Tang Y, Wu WJ, Yang S, et al. Surgical treatment of thoracolumbar spinal tuberculosis—a multicenter, retrospective, case-control study. J Orthop Surg Res. 2019;14(1):233. Liu R, He J, Fan Q, et al. Clinical efficacy of different surgical approaches in the treatment of thoracolumbar tuberculosis: a multicenter retrospective case-control study with a minimum 10-year follow-up. Int J Surg. 2024;110(6):3178–89. Xu Z, Wang X, Liu Z. One-stage posterior debridement and single-segment interbody fusion for treating mono-segmental lumbar and lumbosacral spinal tuberculosis in adults following minimum 5-year follow-up. J Orthop Surg Res. 2020;15(1):473. Long W, Gong L, Cui Y, et al. Single posterior debridement, interbody fusion, and fixation on patients with continuous multivertebral lumbar spine tuberculosis (CMLSTB). BMC Musculoskelet Disord. 2020;21(1):606. Xu Z, Wang X, Zhang Z, et al. A comparison of three bone graft struts for interbody fusion using a posterior approach for lower lumbar spinal tuberculosis in adults: a midterm follow-up study. BMC Musculoskelet Disord. 2022;23(1):590. Zhong D, Lin L, Liu Y et al. 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World Neurosurg. 2021;147:115–24. Liu Z, Li W, Xu Z, et al. One-stage posterior debridement, bone grafting fusion, and mono-segment vs. short-segment fixation for single-segment lumbar spinal tuberculosis: minimum 5-year follow-up outcomes. BMC Musculoskelet Disord. 2020;21(1):86. Shi J, Tang X, Xu Y, et al. Single-stage internal fixation for thoracolumbar. spinal tuberculosis using 4 different surgical approaches. J Spinal Disord Tech. 2014;27(7):E247–57. Hakim AR, Hidayat AR. Challenges and outcomes of upper cervical spinal tuberculosis surgery in pandemic-case series study. Int J Surg Case Rep. 2024;120:109858. Zhong Y, Tang B, Zhang Z, et al. Clinical efficacy and imaging analysis for the surgical treatment of thoracolumbar infections in elderly patients: a retrospective study. Sci Rep. 2023;13(1):10341. Arrington ED, Smith WJ, Chambers HG et al. Complications of iliac crest bone graft harvesting. Clin Orthop Relat Res. 1996;(329):300–9. Zhong W, Liang X, Tang K, et al. Midterm surgical results of the lamina with spinous process in treating one-level thoracic or lumbar tuberculosis: a retrospective study. Sci Rep. 2020;10(1):22036. Tang K, Zhong W, Wang X, et al. Clinical results of a lamina with spinous process and an iliac graft as bone grafts in the surgical treatment of single-segment lumbar pyogenic spondylodiscitis: a retrospective cohort study. BMC Surg. 2022;22(1):45. Zhang H, Xiao L, Tang M, et al. Spinous Process Combined With a Titanium Mesh Cage as a Bone Graft in the Stability Reconstruction of Lumbar or Lumbosacral Spinal Tuberculosis. Front Surg. 2022;9:818926. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8522383","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":576013267,"identity":"e36b4f46-11db-4adf-8cfa-0f07fe251c88","order_by":0,"name":"Yanghui Jin","email":"","orcid":"","institution":"Hangzhou Red Cross Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yanghui","middleName":"","lastName":"Jin","suffix":""},{"id":576013268,"identity":"52a701a0-441e-4af5-ae34-aed941749ef9","order_by":1,"name":"Zhongqiang Wang","email":"","orcid":"","institution":"Zhejiang University of Traditional Chinese 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Zheng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAw0lEQVRIiWNgGAWjYDCCAwxsDAwGEvX9DCAG8VoqbBhnNpCm5Uwa44YDxGrhu3382YO3bYeZjc8fPvaYh8FOTreBgBbJcwnphnPbDrOZ3UhLN+ZhSDY2O0BAi8EZhmPSvG2Hecxu8JhJ8zAcSNxGWAtjG0iLhHH/GaK1MLNJ85xJMzBgyCFSi+QZNjbJORU2CRI30tIk5xgQ4Re+M+zPJN4YSCTw9x8+JvGmwk6OoBYw4EG4kxjlqFpGwSgYBaNgFGABAL2WPl89N/m3AAAAAElFTkSuQmCC","orcid":"","institution":"Hangzhou Red Cross Hospital","correspondingAuthor":true,"prefix":"","firstName":"Qi","middleName":"","lastName":"Zheng","suffix":""}],"badges":[],"createdAt":"2026-01-05 14:23:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8522383/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8522383/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":100685168,"identity":"46c69fe6-d2b4-4703-aaba-4c4173cb000f","added_by":"auto","created_at":"2026-01-20 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12:51:31","extension":"docx","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":17057,"visible":true,"origin":"","legend":"","description":"","filename":"Table3.docx","url":"https://assets-eu.researchsquare.com/files/rs-8522383/v1/b961d2b8bfb28ae15002b9dc.docx"},{"id":100685393,"identity":"c55de733-7420-4abd-969f-8a805335bd6c","added_by":"auto","created_at":"2026-01-20 12:53:01","extension":"json","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":7489,"visible":true,"origin":"","legend":"","description":"","filename":"b8a149ae337347d38b4825dac700b2b7.json","url":"https://assets-eu.researchsquare.com/files/rs-8522383/v1/723206250016a0ecfc017d6e.json"},{"id":100685218,"identity":"0494a8bf-39a6-4e1e-ad93-aa1f3c6ab9e9","added_by":"auto","created_at":"2026-01-20 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12:50:23","extension":"png","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":568108,"visible":true,"origin":"","legend":"","description":"","filename":"Fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-8522383/v1/e3e2f636fc5a67653d469bfe.png"},{"id":100685150,"identity":"6fd9e58e-2f58-40d7-807c-520e98968700","added_by":"auto","created_at":"2026-01-20 12:49:58","extension":"png","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":619837,"visible":true,"origin":"","legend":"","description":"","filename":"Fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-8522383/v1/ad5de0c06d0e3a25392cafb3.png"},{"id":100685096,"identity":"d8e6eb58-3c36-4567-be0c-ca46db828ff6","added_by":"auto","created_at":"2026-01-20 12:49:09","extension":"png","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":145723,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig1.png","url":"https://assets-eu.researchsquare.com/files/rs-8522383/v1/cb75973c64b02130bf434aa1.png"},{"id":100685165,"identity":"58bbe79f-04db-4747-891a-9b2efe6a45d8","added_by":"auto","created_at":"2026-01-20 12:50:22","extension":"png","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":155057,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig2.png","url":"https://assets-eu.researchsquare.com/files/rs-8522383/v1/22af9c3974d880ddf6dbacc8.png"},{"id":100685223,"identity":"012a51fb-debd-400c-bc3e-085173be86fc","added_by":"auto","created_at":"2026-01-20 12:51:14","extension":"png","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":169934,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig3.png","url":"https://assets-eu.researchsquare.com/files/rs-8522383/v1/02dfa7ec12f4e93bcc9354de.png"},{"id":100685149,"identity":"8334e77d-d766-4a4d-9691-4e41f39dd782","added_by":"auto","created_at":"2026-01-20 12:49:58","extension":"xml","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":74765,"visible":true,"origin":"","legend":"","description":"","filename":"b8a149ae337347d38b4825dac700b2b71structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8522383/v1/f62ea24924b0ac2fd6e0bc41.xml"},{"id":100685219,"identity":"788fe365-9046-4252-941e-beebaa4a78b3","added_by":"auto","created_at":"2026-01-20 12:51:11","extension":"html","order_by":16,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":84142,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8522383/v1/5fbd835a7e05c7f2d8a9b034.html"},{"id":100685345,"identity":"2e574f8a-3426-4b1c-a90d-efc4ec5b2bf8","added_by":"auto","created_at":"2026-01-20 12:52:49","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":822288,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe steps for preparing the autologous LSP were as follows. A\u003c/strong\u003e The autologous LSP for interbody fusion was obtained in the operation area. \u003cstrong\u003eB\u003c/strong\u003e The soft tissues on the surface of the LSP were meticulously removed before grafting.\u003cstrong\u003e C\u003c/strong\u003e The LSP was trimmed to size with an ultrasonic bone scalpel. \u003cstrong\u003eD, E\u003c/strong\u003e The remaining bone was morselized for subsequent packing into the n-HA/PA66\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-8522383/v1/7e1d0240b784f412ab96f6a9.png"},{"id":100685015,"identity":"dda5dc46-bcf5-428a-b6c9-5b2e023c9c9c","added_by":"auto","created_at":"2026-01-20 12:48:32","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":568108,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA patient with L4-5 spinal tuberculosis obtained a composite bone graft (LSP + n-HA/PA66) for reconstruction. A\u003c/strong\u003e Preoperative X-rays showed slight narrowing of the L4/5 disc space. \u003cstrong\u003eB,C\u003c/strong\u003e Preoperative CT revealed bone destruction in the L4 and L5 vertebrae. \u003cstrong\u003eD\u003c/strong\u003e Preoperative MRI showed abscesses anterior and posterior to L4/5 with spinal canal involvement.\u003cstrong\u003e E\u003c/strong\u003e Postoperative X-rays (3 days) showed good position of the bone graft and internal fixation.\u003cstrong\u003eF, G\u003c/strong\u003e Postoperative CT (9 months) showed basic fusion of the L4/5 graft. \u003cstrong\u003eH \u003c/strong\u003ePostoperative MRI (9 months) showed near-complete absorption of the abscesses.\u003c/p\u003e","description":"","filename":"Fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-8522383/v1/8f5ac5ab8fa653b6949320a2.png"},{"id":100685346,"identity":"c55cc315-d826-45f6-a183-b57f22cb2e2a","added_by":"auto","created_at":"2026-01-20 12:52:51","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":619837,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA patient with L4-5 spinal tuberculosis obtained an autologous iliac bone graft for reconstruction. A\u003c/strong\u003e preoperative lateral X-ray showed an irregular, worm-eaten L5 upper endplate. \u003cstrong\u003eB,C\u003c/strong\u003e Preoperative CT (sagittal) showed bone destruction in L4 and L5. \u003cstrong\u003eD\u003c/strong\u003e Preoperative MRI T2 revealed a high signal in the L4/5 disc and adjacent vertebrae, with a posterior abscess compressing the dura. \u003cstrong\u003eE\u003c/strong\u003e Lateral X-ray at 2 weeks post-op showed satisfactory fixation and iliac bone graft. \u003cstrong\u003eF, G\u003c/strong\u003e Postoperative CT (6 months) showed good bone fusion. \u003cstrong\u003eH\u003c/strong\u003e Postoperative MRI (6 months) showed improved vertebral signal and basic absorption of the abscess.\u003c/p\u003e","description":"","filename":"Fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-8522383/v1/9f22d2a491db3e84835fb2a6.png"},{"id":108007303,"identity":"91dae9b5-b4e2-475b-b3c4-5bf057c74bf2","added_by":"auto","created_at":"2026-04-28 12:59:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2928374,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8522383/v1/1e6a806f-fe06-4a4e-b9e3-d2d241b9dcd5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical Outcomes of Posterior Surgery with Autologous Lamina Spinous Process Bone and Nanohydroxyapatite/Polyamide-66 for Single-Segment Lumbar Tuberculosis","fulltext":[{"header":"Background","content":"\u003cp\u003eThe 2024 World Health Organization (WHO) Global Tuberculosis Report shows that tuberculosis is now the top cause of death from a single infectious disease worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Spinal tuberculosis (STB) is the most common type found outside the lungs, and it usually affects the lower back. This disease can break down the spinal bones, collapse the space between them, and cause a hunched-back deformity [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Surgery and anti-tuberculosis drugs are a key way to treat it. The anterior-posterior method is a traditional and good way to fix lumbar tuberculosis because it uses both front and back methods. But it causes a lot of tissue damage, major blood loss, and has higher risks [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Therefore, the posterior-only approach has become a common and effective surgery over the past ten years [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. After debridement, surgeons use various materials for spinal support, such as autologous iliac bone, titanium mesh, and allograft, which are often effective [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, these methods carry risks, including chronic donor site pain, hematoma, non-union, and mesh subsidence. LSP offers advantages like excellent biocompatibility, robust osteogenic capacity, ease of shaping, and structural support [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. But it is not as strong or stable as autologous iliac crest bone. So, this study compared these two materials. One method used a composite bone graft (LSP\u0026thinsp;+\u0026thinsp;n-HA/PA66). The other used autologous iliac bone. We looked at patient recovery and radiographic results. We wanted to see if the new method works for lumbar tuberculosis bone defects. Our goal was to check if LSP with n-HA/PA66 can be a good choice for surgery.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatient selection\u003c/h2\u003e \u003cp\u003eInclusion criteria: (1) aged over 18 years, with confirmed STB in the lumbar spine (L1\u0026ndash;S1); (2) only one segment was involved, or multiple segments were affected, but only one required surgery; (3) presence of spinal neurological impairment or paravertebral abscess limited to affected vertebrae; (4) spinal instability or deformity with progressive worsening tendency;\u003c/p\u003e \u003cp\u003eExclusion criteria: (1) history of lumbar surgery or congenital spinal deformity potentially interfering with postoperative assessment; (2) multilevel lesions needing surgical intervention; (3) extensive surrounding abscess with distant tracking unsuitable for posterior surgical clearance; (4) significant psychiatric disorders with poor medication compliance; (5) active TB or other contraindications, including severe coagulation disorders.\u003c/p\u003e \u003cp\u003eStudy Cohort: The study included 39 patients with lumbar tuberculosis. These patients met all selection criteria. They were treated between January 2018 and December 2023. All patients underwent a posterior-only surgical approach consisting of lesion debridement, pedicle screw instrumentation, and interbody fusion. Patients were divided into two groups based on the bone graft they received. Group A (19 patients) was grafted with a composite bone graft, and Group B (20 patients) received autologous iliac bone.\u003c/p\u003e \u003cp\u003eMost patients came to the hospital with low back pain. Many also had pain going down their legs. Some felt numbness in their legs. The severity of these symptoms varied among patients. X-ray and computed tomography (CT) demonstrated varying degrees of narrowing in the affected intervertebral spaces, accompanied by bone destruction in the adjacent vertebral bodies. Magnetic resonance imaging (MRI) findings revealed edema in the involved vertebral bodies, along with the formation of intervertebral or epidural abscesses. All patients had high ESR and CRP levels. These are blood tests that show inflammation. The two groups were similar in their basic characteristics before treatment. This similarity makes them suitable for comparison. The details are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral data of two groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup A\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup B\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStatistical value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex (M/F)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10/9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12/8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2.309\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.191\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (Y)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65.05\u0026thinsp;\u0026plusmn;\u0026thinsp;12.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.20\u0026thinsp;\u0026plusmn;\u0026thinsp;10.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.492\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.626\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDisease course (months)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.53\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.35\u0026thinsp;\u0026plusmn;\u0026thinsp;2.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.858\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative ESR (mm/1h)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.95\u0026thinsp;\u0026plusmn;\u0026thinsp;22.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.85\u0026thinsp;\u0026plusmn;\u0026thinsp;21.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-0.686\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.497\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative CRP (mg/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.47\u0026thinsp;\u0026plusmn;\u0026thinsp;24.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.15\u0026thinsp;\u0026plusmn;\u0026thinsp;17.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-0.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.920\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative VAS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.26\u0026thinsp;\u0026plusmn;\u0026thinsp;1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-1.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative ODI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.95\u0026thinsp;\u0026plusmn;\u0026thinsp;4.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-0.903\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.372\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative Cobb angle\u0026nbsp;(\u0026deg;)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.89\u0026thinsp;\u0026plusmn;\u0026thinsp;3.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.30\u0026thinsp;\u0026plusmn;\u0026thinsp;4.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-0.300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.766\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative ASIA (A/B/C/D/E)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0/0/2/8/9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/0/3/9/8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eZ=-0.169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.866\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003en: number of patients. M: male; F: female; Y: years; ODI: Oswestry Disability Index; VAS: visual analogue scale; ASIA: American Spinal Injury Association.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePreoperative management\u003c/h3\u003e\n\u003cp\u003eAll patients received a conventional quadruple anti-tuberculosis regimen (isoniazid 0.3 g, rifampicin 0.45 g, ethambutol 0.75 g, and pyrazinamide 1.5 g, administered orally in a single dose before breakfast) for 2\u0026ndash;4 weeks preoperatively. Measures were actively taken to correct hypoalbuminemia and anemia, along with enhanced systemic nutritional support. After systemic conditions improved and ESR and CRP stabilized or began to decline, patients underwent surgery.\u003c/p\u003e\n\u003ch3\u003eSurgical management\u003c/h3\u003e\n\u003cp\u003eAll patients underwent general endotracheal anesthesia and were positioned prone after successful anesthesia induction.\u003c/p\u003e \u003cp\u003eIn Group A, a posterior midline incision was made centered on the affected vertebra under C-arm fluoroscopic guidance. Subperiosteal dissection of the paraspinal muscles exposed the posterior elements of the pathological vertebra and 1\u0026ndash;2 adjacent healthy vertebrae, followed by pedicle screw insertion. The entire LSP was cut off using an ultrasonic osteotome and carefully removed en bloc (Fig.\u0026nbsp;1A). And after meticulous removal of the attached soft tissues (Fig.\u0026nbsp;1B), it was preserved in aseptic moist gauze for subsequent grafting. Subsequently, the facet joint on the more severely affected side of the pathological intervertebral space was resected. A lamina spreader was applied on the contralateral side to restore intervertebral height, followed by placement of a temporary connecting rod to prevent spinal cord injury resulting from segmental displacement. Vertebrectomy, including removal of the intervertebral disks, was performed using a combination of a bone chisel and an ultrasonic osteotome. Moreover, a range of curette sizes were used to achieve full debridement. The lesion area and surrounding abscess were irrigated with hydrogen peroxide and normal saline, and the bony surfaces of the residual vertebrae at the defect margins were prepared. Previously obtained LSP was trimmed to size with an ultrasonic bone scalpel (Fig.\u0026nbsp;1C), and the remaining bone was morselized for subsequent packing into the n-HA/PA66 (Fig.\u0026nbsp;1D, E). This composite graft was then implanted to achieve supported fusion in the bone defect area. After meticulous hemostasis and satisfactory neural decompression were achieved, C-arm fluoroscopy confirmed satisfactory positioning of the internal fixation and bone graft. Subsequently, 2\u0026ndash;4 g of streptomycin was applied locally. The surgical area was sealed with gelatin sponge, two negative pressure drainage tubes were placed, and layered wound closure was performed. Intraoperatively collected pus and intervertebral disc tissue specimens were sent for Mycobacterium tuberculosis culture and pathological examination.\u003c/p\u003e \u003cp\u003eFor Group B, the surgery involved two main stages. First, pedicle screws were inserted as in Group A, but without posterior decompression. Next, an anterior approach was performed. With the patient in the lateral position, an oblique abdominal incision was made. The abdominal muscle layers were separated to access the retroperitoneal space. After protecting the peritoneal contents, the psoas muscle was separated to expose the vertebral body for lesion clearance and decompression. The bone defect was measured and protected with saline-soaked gauze. A separate incision was then made along the anterior superior iliac spine to harvest a tricortical bone graft, which was trimmed to fit the defect. Finally, a drain was placed, and the incision was closed in layers.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure\u0026nbsp;1 The steps for preparing the autologous LSP were as follows. A\u003c/b\u003e The autologous LSP for interbody fusion was obtained in the operation area. \u003cb\u003eB\u003c/b\u003e The soft tissues on the surface of the LSP were meticulously removed before grafting. \u003cb\u003eC\u003c/b\u003e The LSP was trimmed to size with an ultrasonic bone scalpel. \u003cb\u003eD, E\u003c/b\u003e The remaining bone was morselized for subsequent packing into the n-HA/PA66\u003c/p\u003e\n\u003ch3\u003ePostoperative care\u003c/h3\u003e\n\u003cp\u003eBoth drainage tubes were maintained for 3\u0026ndash;5 days postoperatively and removed when the daily output fell below 30 ml. Lumbar spine X-ray and CT scans were performed after drain removal. Patients were permitted to ambulate with brace protection one week postoperatively and were required to wear the brace for at least three months. Antituberculosis chemotherapy was continued for 18 months, with timely regimen adjustments in cases of adverse drug reactions or impaired hepatic/renal function.\u003c/p\u003e\n\u003ch3\u003eFollow-up Protocol and Outcome Measures\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003eFollow-up Protocol and Outcome Measures\u003c/div\u003e \u003cp\u003ePatients were scheduled for monthly assessments of ESR, CRP, and hepatic/renal function. Clinical outpatient follow-ups were conducted at 3, 6, 9, 12, and 18 months postoperatively, with each visit including radiographic evaluations (X-ray, CT, and MRI) of the surgical area. The following outcome measures were employed: (1) Surgical Parameters: Operative time, intraoperative blood loss, and complications. (2) Clinical Outcomes: Pain intensity in the lower back, lower limbs, and iliac graft donor site was assessed using the VAS. Neurological function was evaluated with the ASIA scale, while low back pain-related disability was measured using the ODI [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. (3) Radiographic Outcomes: The sagittal Cobb angle at the involved vertebral level and bone fusion time were assessed using the Eck fusion classification criteria [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were performed utilizing the SPSS software (version 23.0, Chicago, IL, USA). Data that followed a normal distribution are shown as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. We compared differences between groups using t-tests and chi-square tests. We used paired t-tests to compare results before and after treatment in the same group. A P-value less than 0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eClinical Outcomes\u003c/h2\u003e \u003cp\u003eThe mean follow-up periods were 19.37\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3 months for Group A and 19.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74 months for Group B, with no statistically significant difference in follow-up times (p\u0026thinsp;=\u0026thinsp;0.387). Both groups demonstrated statistically significant improvements in ESR, CRP, VAS, ODI, and Cobb angle measurements at all postoperative time points compared to preoperative baseline values (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with these parameters showing continued improvement over time. No statistically significant differences were observed in any of these outcome measures between the two groups at any follow-up interval (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05, Tables \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparisons of clinical results between the two groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup A\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup B\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStatistical value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOperation time (min)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e194.26\u0026thinsp;\u0026plusmn;\u0026thinsp;25.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e229.75\u0026thinsp;\u0026plusmn;\u0026thinsp;33.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-3.720\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBlood loss (ml)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e309.26\u0026thinsp;\u0026plusmn;\u0026thinsp;37.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e347.05\u0026thinsp;\u0026plusmn;\u0026thinsp;50.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-2.630\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFollow-up time (months)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.37\u0026thinsp;\u0026plusmn;\u0026thinsp;1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-0.875\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.387\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean fusion time (months)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;7.138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFollow-up ASIA (A/B/C/D/E)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0/0/1/3/15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/0/0/5/15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eZ=-0.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.924\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKirkaldy-Willis excellence rate (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78.94%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.935\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComplications (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCerebrospinal fluid leakage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.157\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIlium bone-harvesting site pain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;5.449\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDeep vein thrombosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.299\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eComparison of ESR, CRP, VAS, ODI, and Cobb angle at various postoperative time points between the two groups (X\u0026thinsp;\u0026plusmn;\u0026thinsp;S)\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup A\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup B\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStatistical value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAt 2 weeks postoperative ESR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e26.32\u0026thinsp;\u0026plusmn;\u0026thinsp;4.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e28.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-1.911\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.064\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAt 3 months postoperative ESR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e17.63\u0026thinsp;\u0026plusmn;\u0026thinsp;4.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e17.90\u0026thinsp;\u0026plusmn;\u0026thinsp;4.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-0.184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.855\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFollow-up ESR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e10.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10.35\u0026thinsp;\u0026plusmn;\u0026thinsp;2.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-0.418\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.678\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAt 2 weeks postoperative CRP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e25.63\u0026thinsp;\u0026plusmn;\u0026thinsp;4.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e26.50\u0026thinsp;\u0026plusmn;\u0026thinsp;4.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-0.628\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.534\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAt 3 months postoperative CRP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.35\u0026thinsp;\u0026plusmn;\u0026thinsp;2.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-1.272\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.211\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFollow-up CRP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-0.242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.810\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAt 2 weeks postoperative VAS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et=-1.757\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAt 3 months postoperative VAS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.715\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.479\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAt 2 weeks postoperative ODI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e25.32\u0026thinsp;\u0026plusmn;\u0026thinsp;2.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e24.75\u0026thinsp;\u0026plusmn;\u0026thinsp;3.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.550\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.586\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAt 3 months postoperative ODI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e9.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.35\u0026thinsp;\u0026plusmn;\u0026thinsp;1.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.294\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.770\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAt 2 weeks postoperative Cobb angle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e9.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e8.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;1.686\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFollow-up Cobb angle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e10.84\u0026thinsp;\u0026plusmn;\u0026thinsp;1.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.90\u0026thinsp;\u0026plusmn;\u0026thinsp;2.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;1.205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.236\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eHowever, patients in Group B demonstrated significantly longer operative times and greater intraoperative blood loss (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). With the exception of one patient who maintained their preoperative neurological status at the final follow-up, all patients showed neurological improvement (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eRadiological Outcomes\u003c/h2\u003e \u003cp\u003eFollow-up imaging confirmed all patients achieved clinical recovery. The average bone fusion time was 8.68 months in Group A (Fig.\u0026nbsp;2) and 6.75 months in Group B (Fig.\u0026nbsp;3). Group A required significantly more time to achieve bone fusion (p\u0026thinsp;=\u0026thinsp;0.00). According to the Eck fusion criteria, Grade I fusion was achieved in 15 patients (78.94%) and Grade II in 4 patients (21.06%) in Group A, compared to 16 (80.0%) and 4 (20.0%) patients in Group B, respectively. No significant difference in fusion grade distribution was found between the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). At the final follow-up, radiographic imaging confirmed successful bone fusion in all patients, with no instances of nonunion, pseudarthrosis, or implant failure.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure\u0026nbsp;2A patient with L4-5 spinal tuberculosis obtained a composite bone graft (LSP\u0026thinsp;+\u0026thinsp;n-HA/PA66) for reconstruction. A\u003c/b\u003e Preoperative X-rays showed slight narrowing of the L4/5 disc space. \u003cb\u003eB,C\u003c/b\u003e Preoperative CT revealed bone destruction in the L4 and L5 vertebrae. \u003cb\u003eD\u003c/b\u003e Preoperative MRI showed abscesses anterior and posterior to L4/5 with spinal canal involvement. \u003cb\u003eE\u003c/b\u003e Postoperative X-rays (3 days) showed good position of the bone graft and internal fixation. \u003cb\u003eF, G\u003c/b\u003e Postoperative CT (9 months) showed basic fusion of the L4/5 graft. \u003cb\u003eH\u003c/b\u003e Postoperative MRI (9 months) showed near-complete absorption of the abscesses.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure\u0026nbsp;3A patient with L4-5 spinal tuberculosis obtained an autologous iliac bone graft for reconstruction. A\u003c/b\u003e preoperative lateral X-ray showed an irregular, worm-eaten L5 upper endplate. \u003cb\u003eB,C\u003c/b\u003e Preoperative CT (sagittal) showed bone destruction in L4 and L5. \u003cb\u003eD\u003c/b\u003e Preoperative MRI T2 revealed a high signal in the L4/5 disc and adjacent vertebrae, with a posterior abscess compressing the dura. \u003cb\u003eE\u003c/b\u003e Lateral X-ray at 2 weeks post-op showed satisfactory fixation and iliac bone graft. \u003cb\u003eF, G\u003c/b\u003e Postoperative CT (6 months) showed good bone fusion. \u003cb\u003eH\u003c/b\u003e Postoperative MRI (6 months) showed improved vertebral signal and basic absorption of the abscess.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eComplications\u003c/h2\u003e \u003cp\u003eComplications in both groups were effectively managed with symptomatic treatment and showed no further progression. In Group A, one elderly patient developed a deep vein thrombosis in the leg. It resolved after blood thinners. In Group B, five patients experienced donor site pain at the iliac crest. Among these, two patients reported persistent pain for more than one month, which was alleviated with continuous non-steroidal anti-inflammatory drug administration. Additionally, two patients in group B had cerebrospinal fluid leaks during surgery. These patients received stronger antibiotics, and no signs of infection were seen during the 3 months after surgery (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eDrug therapy is the main treatment for STB. It works well for most patients. Some patients need surgery. Patients require surgery if they have serious nerve damage, an unstable spine, or a worsening deformity. The primary goals of this surgery are to debride the tuberculosis infection, promote neurological recovery, and restore spinal stability. While the anterior approach is a common technique that provides direct access to debride the lesion and decompress nerves, it has limitations in effectively correcting deformity. There is also a risk of poor bone healing. Because of this, some surgeons opt for a combined anterior and posterior procedure. However, this extensive approach is more traumatic, resulting in increased blood loss, longer surgery duration, and a higher complication rate [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Recently, more surgeons prefer the posterior-only approach because it is less damaging. It allows screw placement above and below the lesion, and the combination of screws with bone grafting stabilizes the spine and corrects deformities [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. But Shi and others have concerns. The posterior approach damages the spine's posterior column and worsens spinal instability. Moreover, as the lesion is removed without direct vision, the debridement may be incomplete. There is also a risk that tuberculosis bacteria could spread to the posterior soft tissues due to positional changes, potentially contaminating the incision and increasing postoperative infection risk [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study included 19 patients with single-level lumbar tuberculosis. All patients received one-stage posterior surgery. The surgery successfully removed infected tissue. It also placed bone grafts between vertebrae and inserted internal fixation. No patients developed serious problems after surgery. No sinus tracts formed. No surgical site infections occurred. Patients felt much less pain after surgery. No tuberculosis came back at the last check-up. Our experience suggests these points are important during surgery: (1) Remove the facet joint on the worse side. Use a spreader to open the disc space. Tilt the table about 30 degrees away from the operation side. This gives a good view. (2) Fully expose the dura and nerve roots. Protect them with cottonoids and gelatin sponge. This keeps the surgical area clear. (3) Remember that \"complete\" cleaning is never absolute. Try hard to remove all damaged bone, pus, inflamed tissue, dead disc pieces, and bone fragments from the disc space and surrounding area. Therefore, for patients with one-level lumbar tuberculosis, the posterior-only approach represents a viable surgical strategy that can reduce operative time, surgical trauma, and blood loss, while also contributing to shorter hospital stays and accelerated patient recovery.\u003c/p\u003e \u003cp\u003eThe Denis three-column theory states that rebuilding the front and middle parts of the spine is important. This helps posterior spine surgery succeed over time. Lumbar tuberculosis often damages these areas. This damage causes spinal instability or deformity. Current reconstruction strategies following debridement for lumbar tuberculosis include autologous iliac bone graft, allograft, titanium mesh cages, and n-HA/PA66 vertebral support. Autologous structural iliac bone graft has been the preferred choice for many years. Studies show this method works in over 90% of cases [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In our cohort, the mean time of bone fusion was 6.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79 months in group B. However, donor site morbidity remains a major clinical concern, as previous studies have reported complication rates of up to 40%, including pain, nerve injury, hematoma, infection, or fracture [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. While no severe complications such as hematoma or infection occurred in our series, five patients in Group B reported significant donor site pain, managed effectively with continuous non-steroidal anti-inflammatory drugs. Additionally, two patients sustained dural tears during graft impaction due to oversized iliac bone blocks, resulting in postoperative cerebrospinal fluid leakage. Recently, several authors have reported utilizing autologous LSP in one-level lumbar tuberculosis or pyogenic spondylodiscitis [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Zhong et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] treated 35 patients with single-level thoracic or lumbar tuberculosis using LSP. The average bone healing time was 12.90\u0026thinsp;\u0026plusmn;\u0026thinsp;3.91 months. In another study on lumbar spinal infections, Tang et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] observed fusion times of 11.30\u0026thinsp;\u0026plusmn;\u0026thinsp;4.75 months with LSP versus 6.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50 months with iliac bone graft. These results show that LSP can effectively fill bone defects and maintain spinal stability. This gives surgeons another option for reconstruction. However, using LSP alone has some risks. Bone healing may take longer. In some cases, healing may not occur. Patients may need to wear a spinal brace for a longer time after surgery.\u003c/p\u003e \u003cp\u003eIn this study, we used a composite bone graft to reconstruct the anterior and middle columns. All patients in this group achieved bone healing. The average healing time was 8.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48 months. The operative time was 194.26\u0026thinsp;\u0026plusmn;\u0026thinsp;25.95 minutes; this was significantly shorter than Group B. All patients with nerve problems before surgery showed improvement. The healing time in our study was shorter than in reports using LSP alone. We propose that the composite bone graft offers several distinct advantages: (1) Using ultrasonic bone scalpels makes it easy to remove the lamina and spinous process as one solid piece. This technique avoids the need to take bone from the hip. It prevents extra surgical damage and problems related to hip bone removal. (2) The use of en bloc LSP for supportive grafting overcomes the limitations of insufficient mechanical strength when LSP is used merely as morselized bone or as a standalone graft. Combining LSP with n-HA/PA66 gives immediate stability, creates more surface contact, and improves load sharing. These factors help the bones fuse faster. So, for patients with single-level lumbar tuberculosis, this new grafting method is effective. It works best when the bone damage is confined between two pedicles or when the spinal canal has become narrow.\u003c/p\u003e \u003cp\u003eThe one-stage posterior surgery using the patient's own lamina and spinous process bone provides important benefits: minimal trauma, faster procedures, and no need for iliac bone graft. But this technique is not perfect and has some inherent limitations. The use of this bone is limited by its small size. It is not suitable for severe vertebral lesions or large bone defects, and it cannot be used if the lamina or spinous process is already infected. Furthermore, the LSP\u0026thinsp;+\u0026thinsp;n-HA/PA66 graft has a longer fusion time than iliac bone; it might delay healing and could be a risk factor for slow union. The posterior-only approach also presents inherent limitations in debridement efficacy, particularly in achieving complete clearance of paravertebral cold abscesses with distant tracking.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study found that the LSP combined with the n-HA/PA66 composite serves as a viable alternative to autologous iliac bone graft for single-segment lumbar tuberculosis. This technique concurrently reduces operative time and successfully avoids donor site pain. However, it must be noted that this study is limited by its constrained sample size and relatively insufficient follow-up period. necessitating further investigation through larger, prospective studies to validate these findings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eLSP Lamina spinous process\u003c/p\u003e \u003cp\u003en-HA/PA66 nanohydroxyapatite/polyamide-66\u003c/p\u003e \u003cp\u003eVAS Visual analog score\u003c/p\u003e \u003cp\u003eODI Oswestry Disability Index\u003c/p\u003e \u003cp\u003eESR Erythrocyte sedimentation rate\u003c/p\u003e \u003cp\u003eCRP C-reactive protein\u003c/p\u003e \u003cp\u003eASIA American Spinal Injury Association\u003c/p\u003e \u003cp\u003eWHO World Health Organization\u003c/p\u003e \u003cp\u003eCT Computed tomography\u003c/p\u003e \u003cp\u003eSTB Spinal tuberculosis\u003c/p\u003e \u003cp\u003eMRI Magnetic resonance imaging\u003c/p\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e \u003cp\u003e This study was approved by the ethics committee of Hangzhou Red Cross Hospital (clinical trial number: 2025PT201-001). All methods were performed in accordance with the Declaration of Helsinki and the relevant guidelines and regulations. Informed consent to participate was waived by the ethics committee of Hangzhou Red Cross Hospital due to the retrospective nature of the study design.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eAll authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eHangzhou Municipal Health Science and Technology Program Project (ZD20250273)\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eYJ and ZW were responsible for the data collation and primary manuscript generation. YJ and FL were responsible for manuscript editing and contributed to data collection. XY and QZ were the senior authors who performed the surgery and contributed to the study design. The author(s) read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. Global tuberculosis report 2024 [R]. Geneva: World Health Organization; 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTang Y, Wu WJ, Yang S, et al. Surgical treatment of thoracolumbar spinal tuberculosis\u0026mdash;a multicenter, retrospective, case-control study. J Orthop Surg Res. 2019;14(1):233.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu R, He J, Fan Q, et al. Clinical efficacy of different surgical approaches in the treatment of thoracolumbar tuberculosis: a multicenter retrospective case-control study with a minimum 10-year follow-up. Int J Surg. 2024;110(6):3178\u0026ndash;89.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu Z, Wang X, Liu Z. One-stage posterior debridement and single-segment interbody fusion for treating mono-segmental lumbar and lumbosacral spinal tuberculosis in adults following minimum 5-year follow-up. J Orthop Surg Res. 2020;15(1):473.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLong W, Gong L, Cui Y, et al. Single posterior debridement, interbody fusion, and fixation on patients with continuous multivertebral lumbar spine tuberculosis (CMLSTB). BMC Musculoskelet Disord. 2020;21(1):606.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu Z, Wang X, Zhang Z, et al. A comparison of three bone graft struts for interbody fusion using a posterior approach for lower lumbar spinal tuberculosis in adults: a midterm follow-up study. BMC Musculoskelet Disord. 2022;23(1):590.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhong D, Lin L, Liu Y et al. Analysis of Nanohydroxyapatite/Polyamide-66 Cage, Titanium Mesh, and Iliac Crest in Spinal Reconstruction of the Patients with Thoracic and Lumbar Tuberculosis. Neurol India. 2022 Sep-Oct;70(Supplement):S230-S238.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJain AK. Tuberculosis of the spine: a fresh look at an old disease. J Bone Joint Surg Br. 2010;92(7):905\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000;25(22):2940\u0026ndash;52. discussion 2952.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuo C, Wang X, Wu P, et al. Single-stage transpedicular decompression, debridement, posterior instrumentation, and fusion for thoracic tuberculosis with kyphosis and spinal cord compression in aged individuals. Spine J. 2016;16(2):154\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang H, Guo Q, Guo C, et al. A medium-term follow-up of adult lumbar tuberculosis treating with 3 surgical approaches. Med (Baltim). 2017;96(45):e8574.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhong Y, Yang K, Ye Y, et al. Single Posterior Approach versus Combined Anterior and Posterior Approach in the Treatment of Spinal Tuberculosis: A Meta-Analysis. World Neurosurg. 2021;147:115\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu Z, Li W, Xu Z, et al. One-stage posterior debridement, bone grafting fusion, and mono-segment vs. short-segment fixation for single-segment lumbar spinal tuberculosis: minimum 5-year follow-up outcomes. BMC Musculoskelet Disord. 2020;21(1):86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShi J, Tang X, Xu Y, et al. Single-stage internal fixation for thoracolumbar. spinal tuberculosis using 4 different surgical approaches. J Spinal Disord Tech. 2014;27(7):E247\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHakim AR, Hidayat AR. Challenges and outcomes of upper cervical spinal tuberculosis surgery in pandemic-case series study. Int J Surg Case Rep. 2024;120:109858.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhong Y, Tang B, Zhang Z, et al. Clinical efficacy and imaging analysis for the surgical treatment of thoracolumbar infections in elderly patients: a retrospective study. Sci Rep. 2023;13(1):10341.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArrington ED, Smith WJ, Chambers HG et al. Complications of iliac crest bone graft harvesting. Clin Orthop Relat Res. 1996;(329):300\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhong W, Liang X, Tang K, et al. Midterm surgical results of the lamina with spinous process in treating one-level thoracic or lumbar tuberculosis: a retrospective study. Sci Rep. 2020;10(1):22036.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTang K, Zhong W, Wang X, et al. Clinical results of a lamina with spinous process and an iliac graft as bone grafts in the surgical treatment of single-segment lumbar pyogenic spondylodiscitis: a retrospective cohort study. BMC Surg. 2022;22(1):45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang H, Xiao L, Tang M, et al. Spinous Process Combined With a Titanium Mesh Cage as a Bone Graft in the Stability Reconstruction of Lumbar or Lumbosacral Spinal Tuberculosis. Front Surg. 2022;9:818926.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Autologous lamina spinous process, Lumbar tuberculosis, bone graft, Surgery","lastPublishedDoi":"10.21203/rs.3.rs-8522383/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8522383/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo evaluate the key techniques and benefits of autologous lamina spinous process (LSP) bone with nanohydroxyapatite/polyamide-66 (n-HA/PA66) in single-segment lumbar tuberculosis posterior surgery\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective study analyzed 39 patients with single-segment lumbar tuberculosis. They were treated at our department from January 2018 to December 2023. Based on the graft material, patients were assigned to one of two groups: Group A (n\u0026thinsp;=\u0026thinsp;19) received a composite bone graft (LSP\u0026thinsp;+\u0026thinsp;n-HA/PA66), while Group B (n\u0026thinsp;=\u0026thinsp;20) underwent a traditional autologous iliac bone graft. Surgical parameters, including operative time and blood loss. Clinical outcomes were assessed using the visual analogue scale (VAS) and Oswestry Disability Index (ODI). Inflammatory markers were evaluated with erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Neurological status was graded with the American Spinal Injury Association (ASIA) grade. Radiographic investigation involved measuring the Cobb angle at three time points and checking if the bones had fused.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAll patients were followed up for an average of 19.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53 months. Group A had a shorter surgery time and less blood loss during surgery. These differences were statistically significant. (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Both groups exhibited significant postoperative improvements in ESR, CRP, ODI, and VAS scores at all time points compared to their preoperative baselines (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Neurological function improved in the majority of patients postoperatively. and no significant difference was found in ASIA grades at the final follow-up (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). All patients achieved bone fusion. However, Group A needed more time to reach fusion than Group B. This difference was statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Regarding complications, one elderly patient in Group A developed muscular venous thrombosis in the right lower limb. In Group B, five patients (25%) experienced persistent pain at the iliac crest graft site. The incidence of donor site pain was significantly higher in Group B (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eFor single-segment lumbar tuberculosis, a composite bone graft (LSP\u0026thinsp;+\u0026thinsp;n-HA/PA66) represents a promising grafting method. Compared to traditional autologous iliac bone, this composite graft reduces operative time and blood loss while eliminating donor site morbidity.\u003c/p\u003e","manuscriptTitle":"Clinical Outcomes of Posterior Surgery with Autologous Lamina Spinous Process Bone and Nanohydroxyapatite/Polyamide-66 for Single-Segment Lumbar Tuberculosis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-20 10:53:10","doi":"10.21203/rs.3.rs-8522383/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5e6c3c35-9080-40e6-be96-b3b3974c1fee","owner":[],"postedDate":"January 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T15:27:04+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-20 10:53:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8522383","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8522383","identity":"rs-8522383","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}