Revision surgical treatment of cervical spine infection after radiofrequency ablation of cervical spine

English Keywords:Cervical revision surgery  Cervical spine infection  Cervical spine radiofrequency ablation

English Abstract:

  【Abstract】 Objectives: To review the effects of revision surgery of cervical spine infection patients after radiofrequency ablation of cervical spine surgery. Methods: Nine patients with cervical spine infection after cervical radiofrequency ablation who underwent revision surgery were retrospectively analyzed from July 2010 to July 2016 in our department including 5 males and 4 females. The mean age was 51.8±4.3 years(34-61 years), the mean follow-up time was 2.8 years(1-3.6 years). All included patients had a recurrence or exacerbation of neurological symptoms within 1 week after receiving cervical radiofrequency ablation, five of whorm had more severe neurological symptoms than preoperative ones. Imaging studies and laboratory tests suggested the existence of cervical infection. Intervertebral space infections were presented in all 9 patients enrolled, concomitant with epidural abscesses in 3 patients and vertebral infection in 1 patient. Radiofrequency ablation before radiofrequency ablation of the 11 segments of the average relative height of 0.19±0.07(0.14-0.25) intervertebral disc, degeneration of grading as: grade Ⅲ in 4 segments, Ⅳ in 7 segments. Radiofrequency ablation surgery segment, postoperative symptom onset time, neurological function score were analyzed to evaluate the height of intervertebral space and disc degeneration in patients before radiofrequency ablation. Results: After radiofrequency ablation, the symptom of recurrence/exacerbation was a mean of 5 days (3-7 days). Five patients had worsening of neurological symptoms over radiofrequency ablation. All cases underwent preoperative cervical spine anterior debridement and bone graft reconstruction surgery. Three patients underwent total hip arthroplasty and grafting and internal fixation, and six patients underwent intervertebral discectomy and fusion fixation. VAS scores and neurological scores of neck and upper extremity pain in all patients after revision significantly improved than those before revision（P<0.05）. VAS scores (neck and upper extremity) at the final follow-up improved from 6.3±1.2 and 5.8±2.1 before revision to 1.6±1.0 and 1.5±0.9, respectively(P<0.05); JOA score improved from 9.5±3.8 before revision to 13.5±3.6(P<0.05). During the follow-up period, no other complications such as bone graft and non-fusion occurred. Conclusions: Cervical revision surgery is an effective method for the treatment of severe cervical spondylosis after cervical radiofrequency ablation. Strict control of cervical radiofrequency ablation indications can effectively reduce the incidence of complications.