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ObjectiveTo explore the clinical diagnosis and treatment of rare primary lumbar intervertebral space infection with Klebsiella pneumoniae and Enterobacter cloacae， and provide clinical experience for the diagnosis and treatment of this rare spinal infection. MethodsAn elderly male patient with low back pain and numbness in the left lower extremity for more than 7 months， which aggravated for more than 1 week， was diagnosed with lumbar disc herniation after laboratory and imaging examinations. After admission， the symptoms became acutely aggravated， and re-examination of lumbar enhanced MRI showed local enhancement at the posterior edge of the L3/4 intervertebral space. The VAS score was 9 points， and the lumbar JOA score was 6 points. A posterior lumbar interbody fusion of L3-L5 was performed， and L3/4 intervertebral disc specimens were collected during the operation for bacterial culture. ResultsBacterial culture results showed Klebsiella pneumoniae and Enterobacter cloacae infection. The patient was treated with sensitive antibiotics for 6 weeks after the operation， and the patient was cured during the follow-up of half a year after the operation. ConclusionFor middle-aged and elderly patients with clinical manifestations of acute severe low back pain or lower extremity pain， the possibility of spinal infection should be considered when routine laboratory and imaging examinations suggest lumbar degenerative diseases.
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OBJECTIVE@#To analyze the clinical characteristics of intervertebral disc tissue injury and herniation into the vertebral body in thoracolumbar fracture on fracture healing, vertebral bone defect volume and intervertebral space height.@*METHODS@#From April 2016 to April 2020, a total of 140 patients with thoracolumbar single vertebral fracture combined with upper intervertebral disc injury treated with pedicle screw rod system reduction and internal fixation in our hospital. There were 83 males and 57 females, aged from 19 to 58 years old, with an average age of (39.33±10.26) years old. All patients were followed up regularly 6 months, 12 months and 18 months after surgery. The patients with injured intervertebral disc tissue not herniated into the fractured vertebral body were the control group, and the patients with injured intervertebral disc and herniated into the fractured vertebral body were the observation group. By detecting the thoracolumbar AP and lateral X-ray films, CT and MRI of the thoracolumbar segment at different follow-up time, calculate the changes of the wedge angle of the fractured vertebral body, the sagittal kyphosis angle and the height of the superior adjacent intervertebral space, the changes of the fracture healing and bone defect volume after the reduction of the vertebral body, and the changes of the intervertebral disc degeneration grade. The prognosis was evaluated by visual analogue scale(VAS) and Oswestry disability index(ODI). Finally, the differences of the above results among different groups were comprehensively analyzed.@*RESULTS@#All the patients had normal wound healing without complications. A total of 87 patients received complete follow-up data, at least 18 months after internal fixation. Thoracolumbar AP and lateral X-ray films showed that 18 months after the reduction and internal fixation operation, the vertebral wedge angle, sagittal kyphosis angle and the height of the upper adjacent intervertebral space in the observation group were greater than those in the control group(P<0.05). CT scanning showed that the deformity of the fracture healed 12 months after the vertebral body reduction in the observation group and formed a "cavity" of bone defect connected with the intervertebral space, and its volume was significantly increased compared with that before (P<0.05). MRI scanning showed that the degeneration rate of injured intervertebral discs in the observation group was more serious than that in the control group 12 months after operation(P<0.05). However, there was no significant difference in VAS and ODI score at each time.@*CONCLUSION@#Herniation of injured intervertebral disc tissue hernias into the fractured vertebral body leads to increased bone resorption defect volume around the fracture and forms a malunion "cavity" connected with the intervertebral space. This may be the main reason for the change of vertebral wedge angle, the increase of sagittal kyphosis angle and the decrease of intervertebral space height after removal of internal fixation devices.
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Male , Female , Humans , Adult , Middle Aged , Young Adult , Vertebral Body/injuries , Lumbar Vertebrae/injuries , Thoracic Vertebrae/injuries , Treatment Outcome , Fractures, Bone , Spinal Fractures/surgery , Fracture Fixation, Internal/methods , Pedicle Screws , Kyphosis/surgery , Intervertebral Disc/surgery , Hernia , Retrospective StudiesABSTRACT
OBJECTIVE@#To study the correlation and clinical value of the arc height of upper and lower endplates, the height of intervertebral space and osteophyte of posterior edge of intervertebral space in patients with cervical spondylosis.@*METHODS@#A total of 108 patients with cervical spondylosis who underwent cervical spondylosis surgery from September 2017 to September 2018 were included in the study. Including 48 males with an average age of 52 years (30 to 72) and 60 females with an average age of 54 years (37 to 79). Among them, C of 6 cases, C of 15 cases, C of 32 cases, C of 42 cases, C of 13 cases. X-ray films of cervical spine were taken before and after operation. The images were accessed by PACS (Picture Archiving and Communication Systems) system. The lower and upper endplate arc heights (L, L), intervertebral space height (L), and posterior osteophyte width (L) were measured. Spearman was used to analyze the correlation between them.@*RESULTS@#L was negatively correlated with L (r=-0.34, 0.05), L and L (>0.05).@*CONCLUSION@#The arc height of the lower endplate is negatively correlated with the width of osteophyte in the posterior margin of the intervertebral space. The cervical degeneration degree can be determined by measuring the arc height of the lower endplate, which has guiding significance for the early prevention and treatment of cervical spondylosis.
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BACKGROUND: Sacral resection has now become the accepted treatment of choice for malignant tumors of the sacrum. There are few biomechanical studies on whether fractures or sacroiliac joint spondylolisthesis will occur after simple sacral resection, and there is no consensus on whether the weight can be fully loaded after subtotal sacral resection and when to rebuild. OBJECTIVE: To contrast clinical research and analyze Von Mises stress to provide a credible theoretic basis about which level of sacrectomy without spinopelvic reconstruction is acceptable for pelvic stability through the biomechanical testing of intact pelvis and models of pelvis after subdivided sacrectomy. METHODS: (1) Biomechanical research: Six fresh normal adult human cadaveric L5-pelvis specimens were chosen. Compressive stress loaded on the specimens was increased by 200 N, until 1 000 N, at the speed of 1.4 mm/min. The change of Von Mises stress was measured to the same pelvic specimens on intact sacrum and groups of subdivided sacrectomy. The differences were compared between groups of data. (2) Clinical studies: Totally 15 patients diagnosed with high sacral tumor with tumor resection between January 2012 and June 2019 were enrolled, including 6 males and 9 females with an average age of 46.40±14.94 years. According to preoperative MRI examination, the extent of sacral involvement was determined, and the size of sacral resection was determined. No reconstruction was performed after operation. Postoperative function and complications were recorded. RESULTS AND CONCLUSION: (1) Biomechanical research: With the growth of the sacrum resection plane, Von Mises stress had different increases at different test points, particularly by 1/4 S1 to 1/2 S1, which were apparently different with that in other groups (P < 0.05). Compared with group 2/3 S2 and group 1/3 S2, the change of Von Mises stress at point A in group S1-2 was not statistically significant. (2) Clinical results: Among the 15 patients, 4 patients retained the intact S1 vertebral body during the operation (resection of the S1-S2 intervertebral space, as in the biomechanics experiment S1-2 group); sacrum was resected in 3 patients as the group 2/3 S2 during the operation, and sacrum was resected in 2 patients during the operation as group 1/3 S2; and the S1 and S2 vertebrae were kept intact in 6 patients (as resection in the S2-3 group). The mean score of musculoskeletal tumor society was 25.27±3.79. All patients were able to walk, nine without walking aids, six with walking aids, one of them developed residual sacral fracture. (3) With the growth of the sacrum resection plane, Von Mises stress at residual sacrum rapidly rose. When the sacrum was resected by S1-S2 intervertebral space, the stability of the pelvic ring was acceptable without spinopelvic reconstruction.
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BACKGROUND: Small-incision extreme lateral interbody fusion and minimally invasive transforamen interbody fusion are widely used to treat patients with lumbar degenerative diseases because of easy operation technology and less serious complications. However, for patients with lumbar degenerative diseases who meet the indications of both surgical methods, how to choose surgical methods needs further study. OBJECTIVE: To compare the clinical outcome between small-incision extreme lateral interbody fusion and minimally invasive transforamen interbody fusion in patients with lumbar degenerative diseases. METHODS: Seventy-six patients with single-segment lumbar degenerative diseases treated from June 2016 to December 2017 were retrospectively analyzed. The patients were divided into small-incision extreme lateral interbody fusion group and minimally invasive transforamen interbody fusion group. Operation time, intraoperative blood loss, postoperative visual analogue scale, Oswestry dysfunction index, Japanese Orthopedic Association score, complications, anterior convex angle of lumbar fusion segment, intervertebral height and intervertebral displacement were compared between the two groups. RESULTS AND CONCLUSION: (1) Operation time and intraoperative blood loss were better in the small-incision extreme lateral interbody fusion group than in the minimally invasive transforamen interbody fusion group (P 0.05). (4) At the last follow-up, the anterior convex angle of fusion segment was larger in the small-incision extreme lateral interbody fusion group than in the minimally invasive transforamen interbody fusion group. The intervertebral height of fusion segment was higher in the small-incision extreme lateral interbody fusion group than in the minimally invasive transforamen interbody fusion group (P 0.05). (5) Both small-incision extreme lateral interbody fusion and minimally invasive transforamen interbody fusion can treat lumbar degenerative diseases effectively. Small-incision extreme lateral interbody fusion is superior to minimally invasive transforamen interbody fusion in terms of operation time, intraoperative blood loss and maintaining the anterior convex angle and intervertebral height of lumbar fusion segment, but incidence of complications is higher.
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BACKGROUND: Studies have found that single nucleotide polymorphism genotypes in the HTRA1 gene promoter region are associated with intervertebral disc degeneration, while HAPLN1 is associated with osteoarthritis caused by intervertebral disc degeneration. OBJECTIVE: To explore the role of human secretory serine protease HTRA1 and the key group of extracellular matrix HAPLN1 in the pathogenesis of intervertebral disc degeneration. METHODS: This study included 498 postmenopausal female subjects who underwent a physical examination at Dingzhou People’s Hospital from April 2015 to December 2018. TaqMan PCR was used to detect HTRA1 gene promoter rs11200638 single nucleotide polymorphism and HAPLN1 gene 5' flanking rs975563, intron 1 rs10942332, intron 2 rs179851 and intron 4 rs4703570 single nucleotide polymorphism in 498 postmenopausal Chinese women. The correlation between the HTRA1orHAPLN1 gene polymorphisms and the radiographic features of spinal disc degeneration was analyzed. The trial has been approved by the Ethics Committee of Dingzhou People’s Hospital. RESULTS AND CONCLUSION: Among the 498 subjects with the HTRA1 gene rs11200638 single nucleotide polymorphism, 178 were GG homozygotes, 222 were GA heterozygotes, and 98 were AA homozygotes. We compared the parameters of intervertebral disc degeneration in subjects with at least one G allele (GG+GA, n=400) and without G allele (AA, n=98). In HTRA1 gene rs11200638 single nucleotide polymorphism, the score on intervertebral space stenosis in the subjects with GG+GA allele genome was lower than that in the subjects with AA allele (P < 0.001). With the increase of the score on intervertebral space stenosis, the proportion of the subjects with AA alleles increased (P ≤ 0.001). Among the 498 subjects with single nucleotide polymorphisms of the HAPLN1 gene, 137 were homozygous for TT, 230 were heterozygous for CT, and 131 were homozygous for CC. Intervertebral disc degeneration parameters of CC+TT allele (n=361) and TT allele (n=137) were compared. In the HAPLN1 gene, there was a significant difference between the CC+TT and TT alleles of the rs179851 single nucleotide polymorphism in osteophyte formation and intervertebral space stenosis (P < 0.01). Among the HAPLN1 gene rs179851 single nucleotide polymorphisms, the proportion of subjects with TT alleles and intervertebral space stenosis ≥ 6 points increased (P < 0.05). With an increase in osteophyte formation score, the proportion of subjects with TT allele increased (P < 0.001). These results reveal that HTRA1 and HAPLN1 genetic variations at specific genetic loci are associated with intervertebral disc degeneration.
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Objective:To observe the effect of distraction before discectomy (DBD) in the distraction of the height of anterior cervical space,and to explore its feasibility in restricting the over distraction.Methods:A total of 31 patients with cervical spondylotic myelopathy were treated with anterior cervical discectomy and fusion (ACDF).During surgery,the intervertebral space was distracted before discectomy,the procedure was defined as DBD technique.Before surgery,the distance from the arch top of inferior endplate of upper vertebrae of the index level to the midpoint of superior endplate of lower vertebrae was measured (H0).The same method was used to measure the adjacent proximal and distal intervertebral space heights (Hp and Hd),and the mean value of Hp and Hd,H,was regarded as a referential height that the index intervertebral space should be restored.During operation,the intervertebral space heights before (H1) and after (H2) discectomy with application of DBD were measured withthe aforementioned method.The pre-and post-operation index segment heights AB and A'B'were measured respectively.The change of index segment height was defined as △H (A'B'-AB),the index intervertebral space height after operation was defined as Hs (H0 +△H).The patients were divided into neck pain group and non-neck pain group according to their post-operative neck pain VAS scores.The radiographic data of the patients in two groups was analyzed and compared with statistical methods.Results:The post-operative neck pain incidence rate was 19.35％.During operation,after DBD,the intervertebral space height change △H1 was (1.19±0.51) mm.In non-neck pain group,the difference between H1 (6.95 mm±0.84 mm) and H (6.98 mm±0.70 mm) was not significant (P=0.80),and the difference between H2 (7.31 mm±0.90 mm) and H1 (6.95 mm± 0.84 mm) was significant (P＜0.01).In neck pain group,the difference between H2 (8.33 mm± 1.39 mm) and H1 (7.87 mm±1.35 mm) was significant (P＜0.01).In neck pain group,the △H was (3.04±0.42) mm;in non-neck pain group,the △H was (1.70±0.51) mm;the difference between two groups was significant (P＜0.01).In nonneck pain group,H1,H2 and H3 had good consistency with H.Conclusion:DBD can effectively control the distraction height of the index intervertebral space within 2 mm,also convenient to let the index intervertebral space be similar with the adjacent segment and easy to follow.
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Objective: To explore the fusion effect of allograft Cages on transforaminal lumbar interbody fusion (TLIF). Methods: The clinical data of 30 patients (38 vertebral segments) who underwent TLIF with allograft interbody fusion Cages between January 2015 and January 2017 were retrospectively analysed. There were 25 males and 5 females with an average age of 56.9 years (range, 44-72 years). The lesions included 20 cases of lumbar disc herniation, 7 cases of lumbar spondylolisthesis, and 3 cases of lumbar spinal stenosis. The operation section included 4 cases of L 3, 4, 13 cases of L 4, 5, 5 cases of L 5, S 1, 6 cases of L 4, 5-L 5, S 1, and 2 cases of L 3, 4-L 4, 5. The disease duration was 6-36 months (mean, 12 months). The clinical effectiveness was evaluated by visual analogue scale (VAS) score, Oswestry disability index (ODI), and Japanese Orthopaedic Association (JOA) score at preoperation, 3 months and 6 months after operation, and last follow-up. The fusion rate was evaluated by anteroposterior and lateral X-ray films and CT three-dimensional reconstruction at 3 and 6 months after operation. The intervertebral space height was measured on anteroposterior and lateral X-ray films at preoperation, 3 days, 3 months, and 6 months after operation. Results: The operation time was 2.1-4.3 hours (mean, 3.1 hours), and the intraoperative blood loss was 150-820 mL (mean, 407.5 mL). The follow-up time was 8-25 months (mean, 16.4 months). One Cage split at 6 months after operation without Cage movement and neurologic symptoms; none of the other patients had Cage prolapse, displacement, and fragmentation. No local or systemic allergy or infection signs was found in all patients. No nerve compression or symptoms was observed during the follow-up. The postoperative VAS score, ODI score, and JOA score improved significantly when compared with preoperative scores ( P0.05). The fusion rate was 55.3% (21/38), 92.1% (35/38), and 100% (38/38) at 3 months, 6 months, and last follow-up postoperatively. The intervertebral space height was increased significantly at 3 days, 3 months, 6 months, and last follow-up postoperatively when compared with preoperative ones ( P<0.05); and the loss of intervertebral space height was significant at last follow-up when compared with postoperative at 3 days ( P<0.05). Conclusion: The allograft interbody fusion Cage contributes to the spine interbody fusion by providing an earlier stability and higher fusion rate.
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Objective: To observe the effect of distraction before discectomy (DBD) in the distraction of the height of anterior cervical space, and to explore its feasibility in restricting the over distraction. Methods: A total of 31 patients with cervical spondylotic myelopathy were treated with anterior cervical discectomy and fusion (ACDF). During surgery, the intervertebral space was distracted before discectomy, the procedure was defined as DBD technique. Before surgery, the distance from the arch top of inferior endplate of upper vertebrae of the index level to the midpoint of superior endplate of lower vertebrae was measured (Ho). The same method was used to measure the adjacent proximal and distal intervertebral space heights (Hp and Hj), and the mean value of Hp and H,i, H, was regarded as a referential height that the index intervertebral space should be restored. During operation, the intervertebral space heights before (H1) and after (H2) discectomy with application of DBD were measured with the aforementioned method. The pre- and post-operation index segment heights AB and A' B' were measured respectively. The change of index segment height was defined as δH (A' B'-AB), the index intervertebral space height after operation was defined as H3 (H0+δH). The patients were divided into neck pain group and non-neck pain group according to their post-operative neck pain VAS scores. The radiographic data of the patients in two groups was analyzed and compared with statistical methods. Results: The post-operative neck pain incidence rate was 19. 35%. During operation, after DBD, the intervertebral space height change δH1 was (1. 19 ± 0. 51) mm. In non-neck pain group, the difference between H1 (6. 95 mm ± 0. 84 mm) and H (6. 98 mm ±0. 70 mm) was not significant (P=0. 80), and the difference between H2 (7. 31 mm ±0. 90 mm) and H1 (6. 95 mm ±0. 84 mm) was significant (P<0. 01). In neck pain group, the difference between H2 (8. 33 mm ±l. 39 mm) and H1 (7. 87 mm ± 1.35 mm) was significant (P<0.01). In neck pain group, the δH was (3.04 ± 0.42) mm; in non-neck pain group, the δH was (1. 70 ± 0. 51) mm; the difference between two groups was significant (P<0. 01). In nonneck pain group, H1, H2 and Ha had good consistency with H. Conclusion: DBD can effectively control the distraction height of the index intervertebral space within 2 mm, also convenient to let the index intervertebral space be similar with the adjacent segment and easy to follow.
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Objective To explore the clinical outcome with anterior debridement,bone graft and posterior internal fixation with short nail of treating intervertebral infection.Methods Ninteen cases (11 male and 8 female,aged from 34 to 63,46 on average) of lumbar intervertebral space infection treated in our hospital from June 2008 to June 2013 were retrospectively analyzed.These infections occurred at L2-L3 in 2 cases,L3-L4 in 5 cases,L4-L5 in 8 cases and L5-S1 in 4 cases.All patients had history of disc surgery or puncture.The clinical outcome after operation was analyzed according to the low back paine after operation which analyzed by visual analog scale (VAS),and the bone fusion.Erythrocyte sedimentation rata and C-reactionprotein were aslo recorded before and after surgery.Results All cases were followed up,average 24 months.The lower back pain was improved obviously between preoperation and postoperation (P ＜0.05).Also erythrocyte sedimentation rata and C-reactionprotein returned to normal after the operation and all cases had complete bone union at the end of follow-up with no instrument failure noted.Conclusion Anterior debridement,bone graft and posterior internal fixation with short nail in of treating intervertebral infection not only can effectively reconstruct the stability of the spine,but also retain range of motion segment of spine.
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Objective:To share a drug treatment experience for multiple drug resistant Pseudomonas aeruginosa.Methods:A retrospective analysis of the pharmaceutical care participated by clinical pharmacist for one case of intervertebral space infection with multiple drug resistant Pseudomonas aeruginosa was carried out.Results:Pharmacists participated in the whole treatment process,made the combined antimicrobial regimen (fosfomycin + ceftazidime + ciprofloxacin),and adjusted the time sequence.As a result,satisfactory curative effect was obtained.Conclusion:The infection with multiple drug resistant Pseudomonas aeruginosa may be treated with the three-drug therapy.Clinical pharmacists can play a positive role in the treatment of complicated infections.
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Objective To compare the clinical effect of PMMA bone cement augmented screw passageway and bone cement-injectable cannulated pedicle screw in treatment of degenerative lumbar disease with osteoporosis. Methods Forty-eight patients with lumbar degenerative disease accompanied with osteoporosis from June 2012 to March 2014 were selected, including 21 males and 27 females with an average age of 64.5 years ( ranged 54 -78 years).There were 17 cases of lumbar degenerative stenosis,18 cases of lumbar intervertebral disc herniation, 8 cases of lumbar degenerative spondylolisthesis,and 5 cases of lumbar degenerative scoliosis.According to the opera-tion method,the patients were divided into two groups.23 cases in group A were treated with bone cement injectable cannulated pedicle screw and 25 cases in group B were treated with PMMA bone cement augmented screw passageway by used conventional screw.Operation time, amount of bleeding and hospitalization time were used to evaluate the clinical characteristics.Visual analogue scale( VAS) score and Oswestry disability index( ODI) were used to evaluate function recovery of post-operative pain and function.The height of intervertebral space,failure rate of internal fixa-tion and bone fusion rate were analyzed by X-ray films postoperative1,3,6,12 months and per year.Results All 48 cases were followed up for 1 -3.5 years.Operation time,amount of bleeding and the time of hospitalization of group A were significantly lower than those in group B(all P0.05).One case of group A had screw fracture,but group B did not appear this kind of situation(P<0.05).Three cases of group B had screw loosening or pullout,but that did not happen in group A.The loss of intervertebral height was (2.7 ±1.7) mm in group A,which in group B was (3.7 ±2.1) mm,there was significant difference between the two groups( P<0.05).According to VAS score and ODI,pain and function in both two groups were improved,but the effect of group A was better than group B(all P<0.05).Conclusion Bone cement-augmentation bone cementinje-ctable cannu-lated pedicle screw may be a safe and effective method in treatment of degenerative lumbar disease with osteoporosis.
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As the disc surgery were extensively developed, the incidence of intervertebral space infection was significantly increased. Due to a lack of specificity, early diagnosis is difficult and it is prone to misdiagnose. Intervertebral disc puncture sampling microorganism culture is a gold standard of antibiotic selection, but the positive detection rate needs to be improved. At present, different medical institutions have different opinious in epidemiology, treatment experiences, the choice of antibiotic treatment, the course of treatment and the way of operation. In recent years, magnetic resonance imaging, fluorine deoxidization glucose positron emission computed tomography scanning, the imaging application mediated percutaneous intervertebral disc, spinal puncture percutaneous endoscopic debridement and lavage drainage and percutaneous internal fixation combined with anterior posterior incision provide more choices for early diagnosis and treatment. Intervertebral infection should attract more attention to the prevention, early diagnosis, early specific pathogens. Doctors' experience and patients' actual situation should be considered when choosing a appropriate treatment. During the treatment, we should be closely monitored laboratory indexes and timely adjust plan of the treatment, and shorten the treatment time and prevent other complications through the auxiliary treatment.
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Objective To discuss and observe the clinical effect of intervertebral pedicle internal fixation and debride?ment combined with bone graft through posterior approach/trans-intervertebral space approach on the treatment of uni/multi-segmental lumbosacral vertebral tuberculosis (TB). Methods A cohort of 37 patients, with single or multiple segmental ver?tebral destruction due to TB, were treated by trans-intervertebral debridement, posterior pedicle screw system internal fixa?tion and intervertebral bone graft. All patients underwent X-ray,CT and MRI examination to observe the combination treat?ment effect. Results Most patients (n=34) enjoyed primary healing, in which include only 4 cases that presented symptom of nerve root stretch injury during operation but all recovered after 3 months. Other 3 patients underwent secondary healing due to sinus but two were rectifying with anti-TB therapy and wound dressing. The other 1 case suffered from sinus tract was healed through second debridement and rectifying therapy. X-ray, CT and MR at 6 months after operation indicated that all patients present great graft osseous fusion, good recovering of height of vertebral body without kyphosis deformity nor internal fixation loosening nor screw breakage. Conclusion Intervertebral pedicle internal fixation and debridement combined with bone graft through posterior approach/trans-intervertebral space approach is with minimum invasion but good graft fusion ef?fects, harder fixation and satisfactory clinical effects in the treatment of uni/multi-segmental lumbosacral vertebral tuberculosis.
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[Objective] To investigate the height change of intervertebral space after anterior cervical fusion and its relation to neck axial symptoms.[Method]Totally 122 patients receiving anterior cervical fusion were followed up for 2 to 5 years,average 3.9 years.The height change of intervertebral space of the fused segment on X-rays were evaluated before,3 months and 2 years after operation.All patients were classified into 3 groups by means of the postoperative height change of intervertebral space.The axial symptoms after operation were observed and analyzed during follow-up.[Result]The incidence of neck axial symptoms was 54.55%,25.84% and 45.45%,respectively.There were significant differences in statistical analysis in group A group B,group B to group C(x2=7.18,P0.0125).[Conclusion]There is significant relation between height change of intervertebral space and neck axial symptoms after anterior cervical fusion.
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[Objective]To evaluate the outcome on patients with primary infection of intervertebral space of the thoracolumbar spine following combined one-stage debridement,strut grafting and internal fixation.[Method] From May 1999 to February 2006,18 patients with spontaneous infection of intervertebral space were analyzed retrospectively.These infections occurred at thoracic spine in 3 cases(16.7%),thoracolumbar junction in 2 cases(11.1%),lumbar spine in 10 cases(55.5%),and lumbosacral junction in 3 cases (16.7%).Their clinical data and outcome were studied.None of all had previous spinal surgery or spinal injection,and their diagnosis were confirmed by histopathology after surgery.All patients were treated by one-stage debridement,strut grafting and internal fixation after failure of nonsurgical treatment.Antibiotics was used following debridement in the infection sites,and was continued to be administered after surgery.Patients were evaluated before and after surgery in terms of pain,neurologic level,sagittal spinal balance,and radiologic fusion.[Result]Postoperatively,all patients experienced significant relief of symptoms,and no fever.Six patients showed improved neurological status(at least one grade improvement on Frankel's functional classification).Only 3 of 18 cases had a positive culture result that pathogen identified Staphylococcus aureus.Histological examination of the specimen after surgery revealed that inflammation occurred in all patients,but no evidence of tuberculosis.The period of follow-up ranged 13 to 45 months with a mean of 26 months.No evidence of recurrence or residual infection was observed in any patient.Postoperative radiological evaluation revealed that implants were stable,there was no phenomena of prosthesis subsidence,hook dislodgment and failure restoration of spinal segments height.Solid bony fusion was obtained in all patients.Eight patients were misdiagnosed for spinal tuberculosis.[Conclusion] One-stage eradication of the infection,strut grafting and internal fixation are effective treatments for primary infection of intervertebral space.The presence of the instrumentations at the site of infection has no negative influence on the course of infection healing.