The treatment of lumbar intervertebral infection via single-stage posterior midline incision and bilateral muscle gap ap-proach / 中华骨科杂志

ABSTRACT

Objective To evaluate the effect of treatment of the intervertebral infection via single?stage posterior midline incision and bilateral muscle gap approach. Methods A retrospective of 39 cases (male 25 cases, female 14 cases) of lumbar in?tervertebral infected patients from October 2012 to December 2014 who were treated by posterior debridement, interbody fusion using allograft and posterior instrumentation through paraspinal muscle gap approach were analyzed, whose mean age was 48 years (range 11-70 years). According to the confirming diagnosis, patients underwent postoperatively anti?inflammatory or chemotherapy treatment. The disease controlling statues were evaluated based on laboratory results of ESR, CRP;Imaging examinations were tak?en to evaluate the fusion of vertebral body;Clinical effects were evaluated using the Visual Analog Scale (VAS) and the JOA score of lumbar function. Results In these 39 cases of intervertebral infection patients, 8 cases ware diagnosed as pyogenic infec?tious, 25 cases were diagnosed as tuberculosis infections, 2 cases were diagnosed as unknown infections, and brucellosis infec?tious was found in 4 cases. All patients' symptoms were significantly improved. The lower back VAS score average 8.22±0.93 points before operation, average 2.21 ± 0.88 points one week after operation, and an average score of 0.80 ± 0.58 points by the last follow?up time. The lower extremity VAS score average 2.32 ± 1.82 points before operation, average 1.89 ± 0.62 points one week after operation, and an average score of 0.61±0.47 points by the last follow?up time. All patients were followed up for 12-18 months (average 13 months), One patient with pyogenic infectious occurred wound infection 1 week postoperatively, and healed after a repeatedly surgery. No internal fixation loosening, fracture, or segmental collapse was observed ,and good fusion was present in all patients after 12 months. JOA lumbar function score all patients were effective after operation, the improve?ment rate was excellent in 76.9%, good in 17.9%, and passable in 5.2%. Comparing with preoperation, the excellent and good rate was 94.8%. Conclusion The treatment of lumbar intervertebral infection via single?stage posterior midline incision and bi?lateral muscle gap approach was clinically effective, which can completely remove the lesion, and achieve rigid internal fixation.