One-stage debridement, autograft and internal fixation combined with long courses of antibiotics for gram-negative bacterial spondylitis of the thoracic and lumbar vertebrae
LIU Bin
LIU Xiang-yang
HUANG Xiang-wang
WANG Guo-ping
SHENG Bin
Abstract：Objective To evaluate the surgical treatment method and effectiveness of gram-negative bacterial ( GNB ) spondylitis of the vertebrae.Methods From June 2008 to March 2013, 16 inpatients [ 9 males and 7 females, aged ( 41 - 76 ) years, mean age ( 57.3 ± 13.9 ) years ] suffering from GNB thoracic / lumbar spondylitis were enrolled. All the patients received one-stage debridement and autograft from posterior or posterior combined anterior approach, and posterior pedicle internal ifxation. Postoperative persistent irrigation and drainage were performed until clear. All of patients were followed up regularly after the operation. The pain scores ( visual analogue score, VAS ), nerve function ASIA classification, MacNab evaluation, and the X-ray and Three-dimensional CT scan were performed.Results Operation times were 86 - 224 min ( mean 142.3 min ), bleeding 120 - 1200 ml ( mean 427.5 ml ), Postoperative persistent irrigation and drainage had lasted for 9 - 19 days ( mean of 13.4 days ). All patients were followed up for 44.7 months on average ( range 20 - 76 months ). The postoperative VAS scores of pain at 3 months ( 2.38 ± 0.86 ), 6 months ( 1.36 ± 0.86 ), 12 months ( 0.70 ± 0.71 ), and last follow-up ( 0.59 ± 0.59 ) were signiifcantly decreased when compared with preoperative score ( 7.66 ± 1.03 ) (P< 0.05 ). The nerve function ASIA classiifcation and last follow-up were significantly improved when compared with preoperative values, the differences were statistically signiifcant (P< 0.05 ). Based on the modiifed MacNab criteria, the results were excellent in 10 cases, good in 3 cases, fair in 2 cases, and poor in 1 case at 12 months after the operation, and the excellent and good rate was 81.3%. 1 case experienced clinical recurrence which was conifrmed by blood culture. Imaging scores at last follow-up ( 4.82 ± 0.18 )were signiifcantly improved when compared with the preoperative value ( 1.32 ± 0.23 ) (P < 0.05 ).Conclusions One-stage debridement, autograft and posterior pedicle internal ifxation combined with postoperative irrigation and drainage is an effective and feasible surgical method for GNB spondylitis. Selecting antibiotics based on the result of drug sensitivity test, and ensure the course more than 8 weeks, also are the key points for treatment.
Keywords：SpondylitisGram-negative bacteriaTherapeutic irrigationDebridement
Publication Date：2016-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 539-544 )