Abstract:

Objective To investigate the effect and value of one stage debridement and internal fixation of bone combined with drainage on treating non-specific primary thoracolumbar infection.Methods The pre- and post-operation clinical data were collected from 46 patients with primary thoracolumbar non-specific infection admitted in the department of orthopedics of the Chest Hospital of Hebei Province from July 2012 to June 2016. Those patients included 4 cases with infection in thoracic, 5 cases in thoracolumbar, 33 cases in lumbar, and 4 cases in lumbosacral. All patients received anti-inflammatory treatment for 2 to 4 weeks before operation. One stage debridement and internal fixation of bone combined with drainage was conducted. The average drainage time after operation was (14.0±4.3) days, ranged from 3 to 28 days. Pain relief, infection control situation, time to getting the patient out of bed after surgery, recovery of neurological function, and bone graft fusion were observed, and the efficacy was evaluated.Results Among the 46 cases in this study, 15 cases were bacterial culture positive, with a positive rate of 32.6%. The visual analogue scale (VAS) score at the third week was (2.59±0.20); compared with preoperative (7.09±0.25), the difference was statistically significant (t=11.35, P<0.05). The erythrocyte sedimentation rate (ESR) at the third week after operation was (43.30±3.13) mm/1 h; compared with preoperative (65.98±4.56 mm/1 h), the difference was statistically significant (t=5.45, P<0.05). The C-reactive protein (CRP) at the third week after operation was (17.15±1.10) mg/L; compared with preoperative (34.54±2.43 mg/L), the difference was statistically significant (t=9.63, P<0.05). One case received a second surgery, and the second surgery rate was 2.2% (1/46). Postoperative, the mean time of patients wearing a brace out of bed was (12.6±4.7) days, ranged from 5 to 21 days. Among the 12 patients with preoperative spinal cord nerve dysfunction, American Spinal Injury Association (ASIA) grade recovered form Grade A to Grade B in 1 case, and form A to C in 1 case, from B to C in 1 case, from B to D in 1 case, from C to D in 3 cases, and from C to E in 5 cases. The fusion time of interbody bone graft ranged from 3 to 12 months in 46 cases, and the mean fusion time was (7.6±1.8) months. According to the fusion standards, 35 cases were excellent, 9 were better, and 2 were good, resulting in an excellent and better rate of 95.7% (44/46).Conclusion For patients with non-specific primary thoracolumbar infection who has surgical indication, one stage debridement and internal fixation of bone combined with drainage is safe and feasible. It has the advantages of rapid infection control, pain relief, neurological recovery, and early ambulation and is an effective method in treating non-specific primary thoracolumbar infection.

Key words: Spondylitis, Abscess, Surgical procedures, elective, Bone transplantation, Drainage, Treatment outcome