Role of Autologous Fibula Strut Graft in Surgical Management of Tubercular Spondylitis by Anterior Approach: A Prospective Study

Background Decompression of cord in tubercular paraplegia is a mainstay treatment with favorable neurological improvement. Anterior decompression and stabilization with autologous bone grafts promotes fusion of affected segment of spine and prevents further progression of deformity. The objective of this study is to assess the role of autologous fibula strut graft in correction of tubercular kyphosis without instrumentation.

Methods Twenty patients of tubercular spine (Gulhane Askeri Tip Akademisi type II or III) with paraplegia were treated with anterior decompression, debridement, and stabilization with various autologous bone graft in combination without instrumentation. Patients were further grouped as follows (10 in each group): group A includes patients where autologous fibula strut, rib, and iliac crest grafts were used in combination; group B includes patients where only autologous rib and iliac crest grafts were used. Results were analyzed in terms of neurological recovery (Frankel grade), graft union time (graft uptake), correction and progression of kyphotic deformity, and graft subsidence.

Results Patients in both groups A and B show similar neurological recovery from Frankel grade A/B to E. Group A (fibula strut group) patients show mean correction of 6.7° (3°–22°) in kyphosis with no loss of correction after a 2-year follow-up, whereas patients in group B (nonfibular strut group) show increase in kyphosis in immediate postoperative period without further progression on follow up. Graft uptake was good in all 19 cases, and graft subsidence was seen in 1 patient of group A.

Conclusions Bone grafting is indispensable in surgical management of tubercular spine. It allows fusion of affected segment and prevents further progression of deformity. However, the neurological recovery of patient depends upon the adequate decompression of cord, debridement, and adequate stabilization of anterior and middle column vertebral body height loss. The use of autologous fibular strut graft along with cancellous graft is superior to only cancellous grafts in terms of kyphosis correction.