Transverse process strut and titanium mesh cages in the stability reconstruction of thoracic single segment tuberculosis: a retrospective single-center cohort study

Current update on surgical management for spinal tuberculosis: a scientific mapping of worldwide publications

Introduction

Spinal tuberculosis (TB), or Pott's disease, remains a significant global health issue, particularly in regions with high TB prevalence. Despite antitubercular drug therapy being the primary treatment, surgical intervention is often required in cases of spinal instability or neurological complications. This study aims to conduct a comprehensive bibliometric analysis of worldwide publications related to the surgical management of spinal TB and to compare contributions from orthopaedic surgery and neurosurgery in this field.

Methods

A bibliometric analysis was performed using data from the Scopus database, covering publications from 1896 to 2024. The search strategy focused on terms related to spinal TB and surgical interventions. The analysis included 1,857 publications, which were examined for trends, key contributors, and the evolution of surgical techniques. Metrics such as the number of publications, leading authors, affiliations, countries, and funding sponsors were compared between orthopaedic surgery and neurosurgery.

Results

This study identified a steady increase in the number of publications over time. Key topics evolved from basic surgical methods, including early spinal procedures, to integrating pharmacological approaches alongside surgical techniques, such as antitubercular drugs, advancing into imaging research and procedure research involving refined surgical methods like spinal fusion. The recent phase reflects a shift towards technology-driven approaches, including minimally invasive techniques, artificial intelligence, and machine learning. China emerged as the leading country with the most contributions based on author, affiliations, funding sponsors, and countries. Last, orthopaedic surgery had more publications (274) than neurosurgery (96).

Discussion

In conclusion, spinal TB surgery has evolved significantly, with a notable shift towards advanced, technology-driven approaches. Orthopaedic surgery leads in research output compared to neurosurgery. This bibliometric analysis provides valuable insights into the global research landscape, guiding future studies in the management of spinal TB.

Recent Advances in Nanotechnology-Based Strategies for Bone Tuberculosis Management

Bone tuberculosis, an extrapulmonary manifestation of tuberculosis, presents unique treatment challenges, including its insidious onset and complex pathology. While advancements in anti-tubercular therapy have been made, the efficacy is often limited by difficulties in achieving targeted drug concentrations and avoiding systemic toxicity. The intricate bone structure and presence of granulomas further impede effective drug delivery. Nano-drug delivery systems have emerged as a promising alternative, offering the enhanced targeting of anti-tubercular drugs. These systems, characterized by their minute size and adaptable surface properties, can be tailored to improve drug solubility, stability, and bioavailability, while also responding to specific stimuli within the bone TB microenvironment for controlled drug release. Nano-drug delivery systems can encapsulate drugs for precise delivery to the infection site. A significant innovation is their integration with prosthetics or biomaterials, which aids in both drug delivery and bone reconstruction, addressing the infection and its osteological consequences. This review provides a comprehensive overview of the pathophysiology of bone tuberculosis and its current treatments, emphasizing their limitations. It then delves into the advancements in nano-drug delivery systems, discussing their design, functionality, and role in bone TB therapy. The review assesses their potential in preclinical research, particularly in targeted drug delivery, treatment efficacy, and a reduction of side effects. Finally, it highlights the transformative promise of nanotechnology in bone TB treatments and suggests future research directions in this evolving field.

Effectiveness and safety analysis of titanium mesh grafting versus bone grafting in the treatment of spinal Tuberculosis: a systematic review and meta-analysis

BACKGROUND

To systematically assess the safety and effectiveness of titanium mesh grafting compared with bone grafting in the treatment of spinal tuberculosis.

METHODS

Electronic databases, including PubMed, Embase, Web of Science, and Cochrane Library, were searched from their inception until April 2023. The outcome indicators for patients treated with titanium mesh grafting or bone grafting for spinal tuberculosis include surgical duration, intraoperative blood loss, graft fusion time, American Spinal Injury Association (ASIA) Spinal Cord Injury Grade E assessment, VAS score, lumbar pain score, post-graft kyphotic angle, and postoperative complications. The Newcastle-Ottawa Scale (NOS) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach were used for quality assessment and evidence grading of clinical studies. Funnel plots and Begg's test were employed for bias assessment.

RESULTS

A total of 8 studies were finally included, comprising 523 patients, with 267 cases of titanium mesh fixation and 256 cases of bone grafting. The meta-analysis showed no significant statistical differences in surgical duration (Weighted Mean Difference (WMD) = -7.20, 95% Confidence Interval (CI): -28.06 to 13.67, P = 0.499), intraoperative blood loss (WMD = 16.22, 95% CI: -40.62 to 73.06, P = 0.576), graft fusion time (WMD = 0.97, 95% CI: -0.88 to 2.81, P = 0.304), ASIA Spinal Cord Injury Grade E assessment (Relative Risk (RR) = 1.03, 95% CI: 0.97 to 1.09, P = 0.346), and overall complications (RR = 0.87, 95% CI: 0.49 to 1.55, P = 0.643). Differences in VAS score, ODI lumbar pain score, and post-graft kyphotic angle between the titanium mesh grafting group and the bone grafting group were not significant within the 95% CI range. The rate of postoperative implant subsidence was slightly lower in bone grafting than in titanium mesh grafting (RR = 9.30, 95% CI: 1.05 to 82.22, P = 0.045).

CONCLUSIONS

Both bone grafting and titanium mesh grafting are effective and safe for the surgery, with no significant statistical differences in the results. Considering the limitations of the present study, large-scale randomized controlled trials are warranted to further verify the reliability of this finding.