ArticleJournal of orthopaedic surgery and research2025
Anterior column reconstruction with titanium mesh cage versus autogenous cancellous bone graft for short segmentation fusion after hemivertebra resection in the thoracolumbar spine: a retrospective and finite-element study.
Article in Journal of orthopaedic surgery and research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPosterior hemivertebra resection, combined with anterior column reconstruction by short segmental fusion, is a widely accepted approach in the treatment of congenital scoliosis (CS) caused by hemivertebra. Both autogenous cancellous bone and titanium mesh cages (TMCs) are commonly used for anterior column reconstruction. However, TMCs have gained more attention due to their stability, biocompatibility, and competent mechanical properties. This study compared the clinical and biomechanical performance of autogenous bone and TMCs in CS patients.
methodsWe retrospectively reviewed 117 CS patients with hemivertebra between T10 and L2 who underwent posterior hemivertebra resection, short segmental internal fixation (2-4 segments) and anterior column reconstruction from 2008 to 2020. Based on the methods of anterior column reconstruction, patients were divided into the autogenous bone group and the TMC group, and further subgrouped by preoperative sacral tilt. Coronal and sagittal deformity parameters, intraoperative parameters and complications were analyzed. Additionally, we developed two finite element models of the T10-L2 thoracolumbar spine with a TMC and autogenous bone graft respectively, and evaluated the maximum von Mises stress and range of motion in both models.
resultsIn patients without severe sacral tilt, the main curve showed a significantly greater reduction immediately after surgery in Group 2a (TMC group) compared to Group 1a (autogenous bone group). However, the curve correction was similar between the two groups at the lastest follow-up. In patients with severe sacral tilt, the ues of TMCs significantly prevented the extention of main curve length after surgery (p = 0.04). All 6 reported complications occurred in the autogenous bone group. Finite element analysis revealed that patients with autogenous bone experienced more stress on the screws and rods compared to those with TMC.
conclusionTMC is a suitable implant for anterior column reconstruction after thoracolumbar hemivertebra resection and provides comparable deformity correction as autogenous bone and a lower risk of complications. LEVEL OF EVIDENCE: Level III.
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