Treatment of primary spondylodiscitisby: one-stage extreme lateral debridement, bone autograft and continuously closed irrigation combined with posterior internal fixation

English Keywords:Primary spondylodiscitis  One-stage surgery  Lateral and posterior approach  Closed irrigation drainage

English Abstract:

  【Abstract】 Objectives: To evaluate the clinical outcome of one-stage extreme lateral debridement, bone autograft and continuously closed irrigation combined with posterior internal fixation in treating primary spondylodiscitis. Methods: A retrospective analysis was made on the clinical data of 23 patients with primary spondylodiscitis between August 2010 and June 2016. There were 13 males and 10 females with an average age of 55.2±17.0 years (range, 16-78 years). All patients suffered from single-level spondylodiscitis, including 3 patients at L1/2, 5 patients at L2/3, 8 patients at L3/4, and 7 patients at L4/5. Conservative treatment for 2 weeks resulted in no or poor effect, and thus all 23 cases underwent one-stage extreme lateral debridement, autogenous iliac grafting combined with posterior internal fixation. Tissue samples in focus were collected for bacterial culture and pathological test during operation. Then continuously closed irrigation was applied for 2-3 weeks postoperatively. Antibiotics was administered for 4-6 weeks postoperatively. Prior to and after surgery, the VAS score was used to evaluate the degree of low back pain, the JOA score was used to evaluate the neurological function, and the Barthel index(BI) was used to evaluate the daily living ability. CRP and ESR was also tested pre- and postoperatively. After operation, X-ray and CT were reviewed regularly to evaluate the internal fixation and bone graft fusion. Results: All patients underwent surgery without serious complications. Bacterial culture revealed staphylococcus aureus in 2 case, escherichia coli in 1 case, klebsiella pneumonia in 1 case, streptococcus mitis in 1 case, negative finding in the other 18 cases. Pathological tests indicated acute or chronic inflammation. The mean follow-up was 18.0±3.5 months (range, 12-24 months), and the symptom of pain was relieved significantly. Compared with preoperative ones, lumbar VAS score, JOA score, BI, ESR and CRP level were significantly improved at 1, 3, 6 and 12 months after surgery (P<0.05). The X-ray and CT showed well internal fixation and no recurrent infection. Solid bony fusion was found in all patients at 3-12 months (average, 6.0±1.7 months) after surgery. Conclusions: For patients with primary spondylodiscitis, one-stage extreme lateral debridement, bone autograft and continuously closed irrigation combined with posterior internal fixation has the advantages of complete focus clearance, sufficiently bone autograft, operation safety, reliable imbolization, as well as satistactory clinical effects, and therefore it is an effective method in the treatment of primary spondylodiscitis.