ABSTRACT
Objective To evaluate the efficacy of one stage anterior debridement combined with posterior pedicle screw fixation in the treatment of cervical intervertebral space infection.Methods From June 2010 to June 2016,28 cases were fixed by anterior debridement combined with the posterior vertebral pedicle screws for the cervical intervertebral space infection,19 males and 9 females.The average age was 45-74 years (58±14.5 years old).21 cases (75％) were spontaneous infection,of which 6 cases were diabetes mellitus,15 cases were over 60 years old.The remaining 7 cases (25％) were intervertebral space infection after radiofrequency ablation of the cervical spine.All patients were excluded from tuberculosis and Brucella infection.All patients underwent hematological examination,with emphasis on WBC,ESP and CRP.All patients received JOA score before operation,applied antibiotic according to blood culture and drug sensitive test.All patients underwent one stage anterior debridement combined with posterior pedicle screw fixation,and the operative time and bleeding volume were recorded.After the operation,intravenous antibiotic therapy was continued,and the application of antibiotics was guided according to the results of ESP and CRP,and the time for the application of antibiotics was recorded.Follow up was performed at 3 months,6 months and 1 years after operation respectively.The JOA score and postoperative cervical lordosis Cobb angle were recorded.Results All operations were successfully completed in this group.The operation time was 130-225 min,with an average of 145.5±12.7 min.The intraoperative blood loss was 40-100 ml,with an average of 67±35.2 ml.The incision was healed in one stage.The time of application of antibiotics in 28 patients was 21-87 days,with an average of 30.8±8.7 days.The longest application time of antibiotics was 87 days,and no relapse was found during follow-up.The postoperative JOA score increased from 11.3± 1.2 to three months 14.9 ± 1.96 postoperatively and 6 months 15.1 ± 1.55 and 1 years 16.5±0.48 after operation.The JOA score was significantly higher than that before operation.No significant loss and change of the Cobb angle in the cervical spine surgery were found.All cases had good bone graft fusion at 1 years.Conclusion One stage anterior debridement combined with posterior pedicle screw fixation is a safe and effective method for the treatment of cervical vertebra instability and nerve function injury caused by cervical intervertebral space infection.It provides a new way for the treatment of cervical intervertebral space infection.
ABSTRACT
With the continuously exploration,in recent years,further understanding of anatomical characteristics of the cervical pedicle brings great breakthrough in cervical pedicle screw implantation.In addition,pedicle screw implantation in cervical spine is considered as a technique with high safety and reliability,which can be widely used in cervical trauma fracture,cervical instability,degenerative,inflammatory,benign or malignant tumor,deformity and other neck diseases.Because of the tremendous differences between upper cervical spine (C1,C2) and lower cervical spine (C3-7) in anatomical morphology,cervical pedicle screw implantation in C1 and C2 differs from in lower cervical spine.Due to the similar structure of C3-7,pedicle screw implantation methods are based on the same principle and sharing a few points in common.The pedicle screw technique can be classified in two groups according to the practice methods:navigation technology and manual placement of cervical pedicle screw.Navigation nailing is considered as reliable,easy handing,and with clear operative vision,however,with disadvantages as complex procedures,highly cost operation equipment,and risk in navigation draft.Therefore,manual placement of pedicle screw is more reasonable and practical comparing with the former.In this study,it analyzed anatomical characteristics of lower cervical pedicle and the measurement of pedicle structure,discussed technique of manual placement of pedicle screw in lower cervical spine and biomechanical study of pedicle screw,and summed up the comparison of the advantages and disadvantages of current representative manual placement technology.