Clinical Efficacy Of Extreme Lateral Interbody Fusion Combined With Posterior Internal Fixation In The Treatment Of Primary Thoracic Intervertebral Infection

Objectives:To evaluate the clinical efficacy of extreme lateral interbody fusion（XLIF）combined with posterior internal fixation for the treatment of primary thoracic intervertebral infection.Methods:The clinical data of 12 patients with primary thoracic intervertebral infection treated by thoracic XLIF combined with posterior internal fixation from January 2019 to January 2022 in our hospital were retrospectively analyzed.There were 5 males and 7 females with an average age of 62.5±13.2 years（range,41-79years）.The operative level distribution was as follows:T_6/7（1 case）,T_7/8（2 cases）,T_8/9（1 case）,T_9/10（1 case）,T_10/11（3 cases）,T_11/12（2 cases）,and T₁₂/L₁（2 cases）.The time of surgery,intraoperative blood loss,postoperative bed length,postoperative hospital stay,complications and follow-up of patients were recorded.Visual analogue scale（VAS）and Oswestry Disability Index（ODI）were used to evaluate the functional clinical effect,while white blood cells（WBC）,erythrocyte sedimentation rate（ESR）,and C-reactive protein（CRP）were recorded before operation and during follow-up to evaluate the disease control status.The segmental height,local kyphotic angle and the fusion of the implant were evaluated by X-ray or CT.Results:All patients underwent successful surgery,with an average operation time of 205.4±20.1 minutes（range 180-245 minutes）and an intraoperative blood loss of 168.3±47.8ml（range 100-250ml）.The mean postoperative ambulatory time was 4.3±1.3 days（range 3-7 days）and the postoperative hospital stay was 10.6±2.4days（range 7-14 days）.Follow-up ranged from 10 to 45 months,with a mean of23.6±11.4 months.All patients showed improvement in their inflammatory markers,returning to normal within 3 months after surgery.The postoperative VAS score significantly decreased from 7.58±1.24 to 3.17±0.72,2.25±0.62,1.83±0.72,and0.92±0.67 at 1 week,1 month,3 months,and the last follow-up,respectively（P<0.05）.Similarly,ODI scores were 73.33±6.40%,30.50±4.44%,23.17±4.04%,and 12.50±3.09%at preoperatively,1 month postoperatively,3 months postoperatively,and at the last follow-up,respectively,with statistically significant differences at each follow-up point compared to preoperative（P<0.05）.Three patients with neurological symptoms before surgery regained neurological function,improving from Frankel grade D to grade E.The segmental height increased from41.45±6.14mm preoperatively to 50.99±7.93mm postoperatively（P<0.05）,but there was a decrease in height of 2.96±1.47mm at the last follow-up.The local kyphosis angle also decreased significantly,from 17.29±10.71°preoperatively to 8.33±4.83°postoperatively（P<0.05）,but an angle loss of approximately 1.11±0.94°was observed at the last follow-up.During the follow-up period,there were no cases of infection recurrence or loosening or fracture of internal fixation.All patients had bone fusion.However,two patients developed pleural effusion requiring repositioning of chest drains.Conclusions:The clinical efficacy of thoracic XLIF combined with posterior internal fixation in addressing primary thoracic intervertebral infection is satisfactory.This surgical technique offers numerous benefits,including minimal trauma,reduced blood loss,quicker postoperative recovery,and a higher bone graft fusion rate,which is a safe and effective minimally invasive surgical approach for the treatment of thoracic infection.