关键词: 脊柱炎, 化脓, 外科手术, 选择性, 治疗结果, 数据说明, 统计

Abstract: Objective

To evaluate the feasibility, clinical and radiological outcome of single-stage debridement, spinal fusion and internal fixation through a posterior approach in the surgical management of patients with pyogenic spondylodiscitis.Methods From January 2012 to December 2016, 31 inpatients (19 males and 12 females; aged 33-79 years; mean age, 60.7±11.2 years) suffering from pyogenic spondylodiscitis were included. All the patients received a single-step radical debridement of the infected intervertebral disc space, posterior screw-and-rod instrumentation and spinal fusion. Intravenous or oral antibiotics were continued for 12 weeks postoperatively and patients were followed up routinely after the operation. The lesion was located in lumbar spine in 23 patients and thoracic spine in 8 patients. There were 17 patients with neurological dysfunction before the operation, among which 15 cases of ASIA D, 1 case of ASIA C and 1 case of ASIA B. At 1, 3, 6 and 12 months after surgery, X-ray, three-dimensional CT scan and MRI were performed. The changes in pain scores (visual analogue score, VAS) and nerve function based on ASIA classification and the correction of Cobb’s angles were assessed for efficacy evaluation.Results The operation time ranged 112-300 min (mean (184.9±46.9) min). The intraoperative blood loss was 200-1400 ml (mean (537.1±286.6) ml). All patients were followed up for (42.3±15.4) months on average (ranged 12-71 months). One of the 31 patients demonstrated of recurrent infection (3.2% (1/31)). The postoperative VAS scores of pain at 3 months (3.06±1.59), 6 months (1.77±1.28), 12 months (1.03±1.22), and last follow-up (0.42±0.85) were significantly decreased when compared with preoperative score (6.74±1.13) (t values were 13.15, 19.73, 18.12, 24.73, all P values <0.05). Postoperative neurological function was improved after surgery, 16 cases were restored to ASIA E and 1 was restored to ASIA D. The preoperative Cobb’s angle was (26.4±16.8)°in thoracic spine and (31.0±3.2)° in the lumbar spine. One month after operation, these Cobb’s angles improved to (21.4±14.6)° and (21.3±5.2)°, representing mean corrections of 5.0° and 9.7° in the thoracic and lumbar spines, respectively. The differences were statistically significant (t values were 4.41, 13.09, all P values <0.05). At last follow-up, these Cobb’s angles were (22.5±15.0)° and (23.8±4.8)°, representing mean losses of 1.1°(t=3.81, P<0.05) and 2.5° (t=15.30, P<0.05) in the thoracic and lumbar spine, respectively.Conclusion Single-stage debridement, spinal fusion and internal fixation through a posterior approach is an effective and feasible surgical method for pyogenic spondylodiscitis.

Key words: Spondylitis, Suppuration, Surgical procedures, elective, Treatment outcome, Data interpretation, statistical