Safety And Clinical Efficacy Of Surgical Treatment Of Pyogenic And Tuberculous Thoracolumbar Infection In Elderly Patients

Objective:To investigate the safety and clinical efficacy of surgical treatment of suppurative and tuberculous thoracolumbar infection in elderly patients.Method:The clinical and imaging data of 59 elderly patients with infectious spondylitis who underwent one-stage posterior focus debridement,spinal canal decompression and intervertebral bone grafting and internal fixation in our department from January 2012to September 2017 were analyzed retrospectively.We included qualified cases in our study and excluded substandard cases.12 patients were excluded from the study,including 9 loss of outpatient or telephone follow-up and 3 patients who died of other diseases during the follow-up period.According to the pathological results,the patients were divided into two groups:21 patients with pyogenic spondylodiscitis(PS group),with an average age of 75(67-82)years and 26 patients with tuberculous spondylodiscitis(TS group),with an average age of 74(66-80)years.The operative safety parameters of the two groups were recorded,including hospitalization time,intraoperative blood loss,suspended erythrocyte transfusion(perioperative period),operation time,ICU hospitalization days,postoperative complication incidence and recurrence,and the above data were statistically analyzed.For the clinical efficacy,we recorded the VAS,ODI and SF-36 scores before and after operation,evaluated the clinical efficacy,and compared the differences between the two groups;ASIA was used to evaluate the nervous system status of the two groups before and after operation,and compared;the improved MacNab standard was used to evaluate the satisfaction of the two groups of surgical results.The postoperative imaging analysis was to measure the Cobb angle at both ends of the infection on the neutral lateral position of the spine before and during the postoperative follow-up,and to compare the changes of Cobb angle between the two groups.The vertical lateral X-ray films were analyzed at 6months,1 year and the last follow-up to evaluate the bone graft fusion of the two groups.Results:All the 47 elderly patients with infectious spondylitis completed the operation successfully with complete debridement,full decompression,and stable implant.There was no nerve injury and pain were significantly relieved after operation.All patients were followed up for 28.74±13.29(12-68)months,and the average body mass index(BMI)was 20.4(17.1-28.3)kg/m~2.In terms of operative safety,the hospitalization time and ICU time in PS group were significantly less than those in TS group(P<0.05).The time of operation,the amount of blood loss during operation and the amount of suspended erythrocytes transfusion(perioperative period)in PS group were less than those in TS group,but there was no significant difference between the two groups(P>0.05).The total incidence of postoperative complications in both groups was 44.7%(21/47).Only the number of patients with complications was calculated,and there was no overlap when there were multiple complications in the same patient.PS group accounted for 42.9%(9/21)of the patient population,and the complication rate of TS group was 46.1%(12/26).By chi-square test,there was no significant difference between the two groups(P>0.05).In all cases,only 1 case relapsed in TS group.In terms of clinical efficacy,the scores of VAS,ODI and SF-36 of all 47 patients were significantly improved compared with those before operation.After an average follow-up of 6 months,the scores of VAS and SF-36 in the PS group were significantly better than those in the TS group.1 year later,the SF-36 score in the PS group was significantly better than that in the TS group.However,after more than 1 year of operation(the last follow-up),there was no significant difference in the scores of VAS,ODI and SF-36 between the two groups.The neurological status of postoperative follow-up in both groups was improved compared with that before operation,and about83%(39/47)of the patients were satisfied with the results of the operation(according to the modified MacNab standard).In terms of imaging results,bone graft fusion improved in both groups at 6 months,1 year and final follow-up.During the postoperative and the last follow-up,the Cobb angle of the infected spinal segment in the two groups was lost compared with that before operation,but there was no significant difference between the two groups(P>0.05).Conclusion:Surgical treatment can provide satisfactory clinical and imaging results for thoracolumbar infection in elderly patients over 65 years old.Although the incidence of perioperative complications in the elderly is high,it is controllable and surgical treatment is still a safe and effective measure.The hospitalization time and ICU time of TS group were significantly prolonged,but the clinical effect was similar to that of PS group in the long term(more than 1 year).