Clinical efficacy of one-stage posterior debridement, interbody bone grafting and vacuum sealing drainage combined with closed continuous douche drainage in treating primary lumbar spine infection

English Keywords:Primary lumbar spine infection  Paravertebral abscess  Vacuum sealing drainage  Closed continuous douche  Bone graft fusion

English Abstract:

  【Abstract】 Objectives: To observe the clinical efficacy of one-stage posterior debridement and iliac bone interbody fusion combined with vacuum sealing drainage(VSD) for wound closure and closed continuous douche (CCD) for the treatment of primary lumbar spine infection. Methods: A retrospective analysis was conducted on the case data of 18 patients with primary lumbar spine infection who underwent one-stage posterior debridement with iliac bone interbody grafting and VSD incision closure + CCD treatment at our hospital between January 2016 and December 2021. There were 9 males and 9 females, aged 53.2±16.0 years(22-80 years). mNGS sequencing and pathogen culture were employed to identify infectious pathogens and formulate targeted antibiotic treatment plans. The levels of erythrocyte sedimentation rate(ESR) and C-reactive protein (CRP) were measured from preoperative 3d to postoperative 60d(every 3 days) to evaluate the infection control status. Clinical function recovery was assessed using the Barthel index(BI) and JOA scores before surgery and at 3 months postoperatively, calculating the improvement rates(significant improvement defined as ≥60%). The Frankel classification was recorded before operation and at 3 months post-operation to evaluate spinal cord injury recovery. Postoperative follow-up CT scans were conducted to record the time to bone fusion. Results: The combined results of mNGS sequencing and pathogenic culture were positive in 17 cases (17/18), including 8 cases of Staphylococcus aureus, 3 cases of Escherichia coli, 2 cases of Pseudomonas aeruginosa, 1 case each of methicillin-resistant Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecium, and Brucella species was also noted, all of which received appropriate sequential therapy. All the cases were followed up postoperatively for 18.0±8.2 months(12-38 months). The average levels of CRP and ESR returned to the normal ranges on postoperative 42d and 45d respectively and sustained thereafter. The BI was 63.7±11.3 points before operation, which was 89.8±7.0 points at 3 months postoperatively, with 16 cases achieving significant improvement(88.9%); The JOA score was 14.2±3.4 points before operation, which was 25.7±3.1 points at 3 months postoperatively, with 16 cases achieving significant improvement (88.9%). At 3 months after operation, 2 patients with Frankel grade C improved to grade E, 2 improved to grade D, and the remaining 14 patients with Frankel grade D all improved to grade E. The average time for bone graft fusion post-surgery was 6.0±1.5 months. Conclusions: One-stage posterior debridement, iliac bone interbody grafting, and VSD incision closure combined with CCD can achieve thorough debridement, effective infection control, and reliable bone graft fusion in treating primary lumbar spine infection, which can improve neurological function of the patients.