| Objective:To explore the feasibility,safety and clinical efficacy of Oblique Lumbar Interbody Fusion corridor technique in the treatment of single segment lumbar pyogenic spondylodiscitis.Methods:1.From January 2014 to November 2018,patients with single level lumbar pyogenic spondylodiscitis treated by OLIF corridor which contained debridement,iliac bone grafting and lateral screw fixation in our hospital were retrospectively analyzed.2.Pola classification,operation segment,operation time,intraoperative blood loss,preoperative or intraoperative pathogen culture results,length of hospital stay,followup months,preoperative and some follow-up parameters were recorded,including American Spinal Injury Association grade,Numerical Rating Scale,Oswestry disability index,White Blood Cell,C-Reactive Protein,Procalcitonin,Erythrocyte Sedimentation Rate,Modified Macnab Criteria,Global Lumbar Lordosis angle,Disc Space Height and Local Lumbar Lordosis angle.The complications were also recorded.The data were analyzed by t-test or ANOVA.Results:1.There were 32 patients,21 males and 11 females,aged from 38 to 78 years old,with an average age of 59.0±1.9 years old.A total of 10 patients underwent CT guided bacterial culture of puncture specimens before operation,and 6 cases of positive pathogens were detected and detection rate was 60.0%.Preoperative ASIA included 2 cases of C grade,4 cases of D grade and 26 cases of E grade.Preoperative Pola type included 3 cases of A.3 type,1 case of A.4 type,13 cases of B.1 type,7 cases of B.2 type,2 cases of B.3 type and 6 cases of C.1 type.2.There were 2 cases of L1/2,7 cases of L2/3,13 cases of L3/4 and 10 cases of L4/5.The average operation time was 92.8± 12.4 min,range from78 to 182 min.The average intraoperative blood loss was 108.5±32.9 ml,range from 55 to 2200 ml.25 cases of pathogens were detected by intraoperative culture,the positive detection rate was 78.1%.The average hospitalization time was 8.6±2.1 days,range from 5 to 14 days.The average follow-up time was 21.1±2.0 months,range from 18 to 24 months.There were only 1 case of D grade for 18 months after surgery.3.Compared with preoperative status,NRS and ODI decreased by 84.2%and 82.8%,respectively(P<0.001),WBC,CRP,ESR and PCT decreased by 31.4%,93.1%,92.4%,83.3%respectively(P<0.001)after 18 months follow-up.The angle of GLL and SLL changed by 10.6±4.7 ° and 6.8±2.7 ° at 18 months after operation,the difference were statistically significant(P<0.05).The height of DSH at 18 months after operation changed by 6.5±2.1 mm(P<0.01).28 cases were excellent,4 cases were good and all patients had excellent or good outcomes for 18 months after the surgery.4.There were 5 cases complications,including 1 case of intraoperative left common iliac vein injury,which was repaired after using hemostatic materials and blood transfusion and the lower limb swelling occurred and subsided after affected limb elevation and anticoagulation after the operation.1 case of pseudoarthrosis received no special treatment after 9 months follow-up,3 cases of postoperative bone pain received intensive analgesia and the pain symptoms disappeared before discharge.No neurological deficit or infection recurrence at the final follow-up.Conclusion:OLIF corridor technique included debridement,autogenous iliac bone graft fusion and internal fixation can effectively restore the height of intervertebral space and lumbar lordosis angle.It has the advantages of less trauma,short hospital stay and high fusion rate.OLIF corridor technology is effective treatment for lumbar pyogenic spondylodiscitis. |
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