[Infection of intervertebral space and the interventional therapy].

OBJECTIVE: To investigate the effect of interventional therapy in the treatment of intervertebral space infection. METHODS: The needle was punctured into the infected intervertebral space from the post-lateral side of the spine monitored by X-rays. The pus was drained, the degenerative disc tissues and necrosis tissues were excised and taken out, and at the end a drainaging catheter was put into the space through the needle. The patient should lie in bed absolutely. The antibiotics was injected into the space through the silicon catheter every day. Three to four weeks later, the catheter was removed. RESULTS: All the 8 patients got good results after the therapy. The low back pain was dramatically alleviated instantly at the day of operation. Erythrocyte sedimental rate gradually descended. After 3 approximately 4 weeks of treatment,the catheter was removed. CONCLUSION: Interventional therapy of the intervertebral space infection has notable advantage over the open operation.

One-stage surgical management for multilevel tuberculous spondylitis of the upper thoracic region by anterior decompression, strut autografting, posterior instrumentation, and fusion.

STUDY DESIGN: A retrospective clinical study of 1-stage surgical management for multilevel tuberculous spondylitis of the upper thoracic region (MTSUTR). OBJECTIVE: MTSUTR has rarely been documented in the literature. We present a retrospective clinical study of 23 patients with MTSUTR treated by anterior decompression, strut autografting, posterior instrumentation, and fusion. The purpose was to determine the clinical efficacy of such surgical treatment for MTSUTR. SUMMARY OF BACKGROUND DATA: It is considered safe and effective to treat surgically tuberculous spondylitis with local spinal cord compression. Many reports have documented a good clinical efficacy of surgical management for spinal tuberculosis. However, how to deal with MTSUTR is rarely reported in the literature. METHODS: There were 14 men and 9 women, with average age of 35 years. All patients underwent 1 stage anterior debridement, strut autografting, and posterior instrumentation and received combined medication antituberculosis chemotherapy for 12 to 24 months (average 18 mo). The following data were followed up for an average period of 42 months (24 to 60 mo) in these patients: deformity angle, neurologic function, and spinal bony fusion. RESULTS: The average preoperative deformity angle was 44 degrees, correcting to 20-degree postoperatively and 24 degrees at final follow up. In the series, 19 patients with preoperative neurologic deficit restored by 1.3 grades according to Frankel. All patients got bony spinal fusion within 6 months postoperatively. There was no recurrent tuberculous infection. CONCLUSIONS: Single-stage anterior debridement, strut autografting, posterior instrumentation, and fusion proved safe and effective for MTSUTR, which can achieve goals of complete spinal cord decompression and good deformity correction.

[Efficacy of operation in the treatment of cervical spondylotic myelopath in different disease periods].

OBJECTIVE: To analyze the efficacy of cervical spondylotic myelopathc (CSM) in different disease periods after operation, and explore the best operating period for CSM treatment. METHODS: Eighty-nine cases of CSM were included in this study. Thirty-eight cases were treated by posterior open-door or twain-door laminoplasty, and 34 cases were treated by anterior "opening window" decompression and auto-iliac bone graft. According to the disease period, 89 cases were classified into group I (< 6 months), group II (> 6 months, < 12 months), and group III (> 12 months). RESULTS: Seventy-two cases were followed up for an average of 18 months (ranged 10 to 60 months). According to the JOA standand, the statistical results of the postoperative improvement rate of showed that the shorter the course of the disease, the better the surgical result. In patients operated on within 6 months of the disease, the surgical result was the best(P < 0.01), and when the course of disease was beyond 12 months, the operative result was obviously poor (P < 0.01). CONCLUSION: Patients with CSM should undergo operation within 6 months with no contraindication. Even if the disease period is beyond 6 months, patients also should be operated on as soon as possible.

[Anterior approach in the surgical treatment of cervical fracture and spinal cord injury].

OBJECTIVE: To explore value of the anterior approach in the surgical treatment of cervical fracture and spinal cord injury. METHODS: Thirty-one cases of cervical fracture and spinal cord injury were treated. All the patients were operated on in general anaesthesia by anterior decompression, reduction, auto-iliac graft and ORION cervical plate fixation. All the cases were evaluated according to Frankel criteria of the neural function preoperatively, and 3 months and 6 months after the operation. RESULTS: Twenty-eight cases were followed up for an average of 13.8 months (ranging from 3 to 18 months). All the fractures and dislocations were reduced satisfyingly. All the bone-grafts were fused within 3 months after the operation. There was no plate or screw complication in any of the cases. The Frankel grade improvement rates were 50%, and 82.1% in 28 cases at 3 months and 6 months postoperatively; the average Frankel grade was improved by a 0.64 and 1.14 grade respectively. CONCLUSION: For cervical fracture and spinal cord injury, an ideal reduction and immediate stability can be obtained through the anterior approach. Early surgery can significantly improve the spinal cord function and avoid missing the operation opportunity due to occurring complications.