Debridement,Spinal Fusion,and Internal Fixation Through A One-Staged Posterior Approach For Treatment Of Pyogenic Spondylodiscitis:A Clinical Observational Study

Objective To evaluate the clinical and radiological outcome of debridement,spinal fusion and internal fixation through a posterior approach in the surgical management of patients with pyogenic spondylodiscitis.Methods From June 2014 to June 2019,26 inpatients(16males and 10 females: age32-88years;mean age,59.77±23.63 years)suffering from pyogenic spondylodiscitis were include.All patients received debridment of the infected intervertebral disc space,internal fixation and spinal fusion.The lesion was located in lumbar spine in 18 patients,thoracolumbar in 4patients,thoracic spine in 4 patients.Analysis of preoperative clinical symptoms,signs,antibiotic Program,laboratory tests and imaging data.Uesing ESR and CRP to evaluate the infection control of patients preoperative and postoperative.Using ASIA to evaluate the neurological function of patients preoperative and Postoperative.The Cobb angle was used to evaluate the correction of kyphosis in patients,X-ray,CT and MRI were used to evaluate the fusion of lesions.Results The operation time range 120-260min;mean time(173.46±47.53)min.The intraoperative blood was 200-600 ml(mean(330.38±96.14)ml).All patients were followed up for 12-48 months(mean(24.42±12.63)months).Up to the last follow-up,one patient underwent surgery again due to poor infection control,and no recurrence in other 25 patients.The mean time of preoperative antibiotic treatment was(2.46±0.71)weeks,The mean time of postoperative antibiotic treatment was(4.54±0.99)weeks.The preoperative ESR and postoperative ESR at 1 month,3 months,and 6 months was(71.58±29.18)mm/h,(42.54±25.78)mm/h,(17.50±6.97)mm/h,(9.96±2.73)mm/h.The preoperative CRP and postoperative CRP at 1 month,3 months,and 6 months was(48.46±34.68)mg/L,(15.63±10.32)mg/L,(5.15±3.77)mg/L,(2.35±0.39)mg/L.ESR and CRP decreased to normal at the 6th month after operative.The Postoperative VAS scores of pain at 1 month(3.89±1.10),3 months(2.58±0.76),and 6 months(1.30±0.74)were significantly decreased when compared with preoperative scores(6.92±1.57)(P vales<0.05).Postoperative neurological Function was imprvoed after operative,15 cases were restored to ASIA E and 2was restored to ASIA D.The Postoperative cobb’s was(16.00±5.80)°,The postoperative cobb’s at 1 month(9.12±2.36)°,3 months(7.81±2.02)° was statistically significant compared with preoperative(t=6.783,P=0.001;t=7.262,P=0.001).One year follow-up,X-ray and CT showed that 25 patients had been fused,and one patient had poor fusion.All patients had no serious complications.Conclusions Debridement,Spinal fusion,and Internal fixation through a one-staged posterior approach is an effective surgical method for pyogenic spondylodiscitis.