Clinical Research On The Treatment Of Non-specific Chronic Discitis Of Thoracic And Lumbar Under Quadrant System

Objective To explore the clinical effect,Surgical indications,feasibility and safety of Debridement of intervertebral disc Lesion,intervertebral bone graft and pedicle screw fixation assisted by Quadrant system for the treatment of non-specific chronic discitis of thoracic and lumbar,and compare with open operation.Methods Rretrospectively analysis the data of 52 patients From January 2000 to November 2017 who suffered with non-specific chronic discitis of thoracic and lumbar diseases.All of them were divided into two groups according to Operation mode.20 patients underwent intervertebral disc Lesion debridement,interbody fusion and pedicle screw fixation assisted by Quadrant system,there are 8 males and 12 females among them,aged 38-74 years,mean age was 54.7 years old.Staphylococcus aureus infection in 12 cases,Citrobacter infection in the intervertebral space in 1 case,Streptococcus granulosus infection in the intervertebral space in 1 case,Klebsiella pneumoniae infection in the intervertebral space in 2 cases,E.coli infection in the intervertebral space in 2 cases,2 Case culture results were negative.The other 20 patients underwent conventional open surgery.There are 11 males and 9 females among them,aging from 34 to 76 years,mean age was 56.3 years old.Staphylococcus aureus infection in 10 cases,1 case of citrate,2 cases of fungal infection,1 case of Klebsiella pneumoniae,1 case of E.coli,and 4 cases of negative culture results.Compare incision muscle stripping length,postoperative drainage,intraoperative bleeding volume,operation time length,transfusion ratio and ambulation time of two groups,postoperative analgesic use and average hospitalization time.And the clinical efficacy was evaluated with VAS score and ODI score after operation.There was no significant difference in preoperative and postoperative blood routines,erythrocyte sedimentation rates,procalcitonin,and interleukin-6 levels between the two groups of patients.In the group,the levels of procalcitonin and interleukin-6 were significantly decreased after the operation.There was no significant difference in blood routine and erythrocyte sedimentation rate before and after surgery.The cerebrospinal fluid leakage occurred in 1 patient in the Quadrant channel system group,which was cured by drainage,salt-pack pressure,and dressing change after surgery.Results 40 patients showed no loosening,breaking or abnormal activities During the follow-up period,all cases had bone fusion.The patients underwent operation assisted by Quadrant system had 5.24 + 1.42 cm in incision muscle stripping length,155±70ml in amount of bleeding,100 + 26 ml in postoperative wound drainage,5/20 of the application of analgesics proportion after surgery,5.4 + 1.9d in postoperative ambulation time.While the index of Open operation group were 13.50 + 4.27 cm,362 + 122 ml,200ml + 32 ml,13/20,10.1 + 1.6d.The index of Quadrant group was significantly reduced compared with open surgery group.The VAS scores and ODI scores of the patients between the two groups had no difference before operation.In the Quadrant system group,the VAS score was 2.7±1.3 one week after surgery,and the VAS score was 1.5±1.2 at 3 months postoperatively,which was significantly lower than that of the conventional open surgery group.The difference was statistically significant(P<0.05).In the same group,the VAS scores and ODI scores at 1 week postoperatively and 3 months postoperatively were statistically significant(P<0.05).In the Quadrant system group,cerebrospinal fluid leakage occurred in 1 patients and were cured by postoperative salt-pack pressure and dressing changes.Both groups showed bone fusion on the X-rays 3 months after surgery.Conclusion This study applied the Quadrant channel system to the treatment of non-specific chronic disc infection of the thoracolumbar spine for the first time.Compared with the traditional open surgery,the Quadrant channel system has the same curative effect;the Quadrant channel system has the advantages of less soft tissue damage,less bleeding,less postoperative pain,and lower time Early,short hospital stay,rapid postoperative recovery;no recurrence after surgery,with good clinical efficacy;can be applied to the treatment of non-specific infection of thoracolumbar spine.