Clinical Study For The Treatment Of Lumbar Intervertebral Space Infection Via Single-stage Posterior Muscle Gap Approach Combined With Debridement, Bone Grafting And Internal Fixation

Objective:To evaluate the effect of treatment of the intervertebral infection via single-stage posterior midline incision and bilateral muscle gap approach. Methods:A retrospective analysis of 82 cases of lumbar intervertebral infected patients from October 2012 to May 2014 who were treated.The number is consist of 14 purulent infections,11 brucellosis infections,17 unknown infections and tuberculous infections.All patients adopted posterior paraspinal muscle gap approach to operation. Imaging evaluated the fusion of vertebral body; Clinical effect evaluaed from the Visual Analog Scale (VAS) and the JOA score of lumbar function.Results 82 cases of patients’ symptom were significantly improved. The VAS of purulent group:average 8.78±0.97 points before operation, average 2.36±0.84 points one week after operation, and an average score of 1.00±0.68 points by the last follow-up time. The VAS of brucellosis group:average 8.78±0.97 points before operation, average 2.55±0.69 points one week after operation, and an average score of 1.09±0.54 points by the last follow-up time.The VAS of unknown group:average 8.12±0.93 points before operation, average 2.47±0.62 points one week after operation, and an average score of 0.88±0.60 points by the last follow-up time.The VAS of tuberculous group:average 7.25±0.71 points before operation, average 2.85±0.98 points one week after operation, and an average score of 1.50±0.93 points by the last follow-up time. The JOA lumbar function score:all patients was effective after operation, the improvement rate was excellent in 68.29%, and good in 24.39%,and passable in 7.32%.Comparing with preoperation,the score was significantly reduced.All patients were followed up for 12-18 months (average 13 months), Two patients had wound fluided after opertion, and healed after a repeatedly surgery; Another two patients was infected several months later, and healed after a second surgery. X-ray showed that 75 patients were bony fusion, and 6 patients didn’t meet the confertus standart, they didn’t have any symptoms.Conclusion The Treatment of lumbar intervertebral infection via single-stage posterior midline incision and bilateral muscle gap approach provides the patients a good method of treatment that can completely remove the lesion, and a rigid internal fixation.The clinical efficacy is satisfied.