Channel-assisted minimally invasive interbody fusion and short segmental vertebral fixation for the treatment of non-specific lumbar intervertebral infection

Abstract

To explore the clinical effect of channel-assisted minimally invasive transforaminal lumbar interbody fusion combined with percutaneous short segmental vertebral fixation for the treatment of non-specific lumbar intervertebral infection. The clinical data of 12 patients with non-specific lumbar intervertebral infection treated from January 2014 to January 2018 were retrospectively analyzed. There were 8 males and 4 females, aged 39 to 65(51.00±12.36) years old. Infection site located in L2, 3 of 2 cases, L3, 4 of 3 cases, L4, 5 of 6 cases, L5S1 of 1 case. There were 3 cases of hypertension, 2 cases of diabetes, and 2 cases of urinary tract infection. None of the 12 patients had a history of lumbar puncture and surgery. Debridement, autogenous bone grafting, minimally invasive transforaminal lumbar interbody fusion via Quadrant invasive system, and percutaneous short segmental vertebral fixation were performed in the patients, the diseased tissue samples were collected for bacterial culture and pathological examination. The operation time and the amount of intraoperative blood loss were recorded. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured before and after operation. Visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) scores were used to evaluate the clinical effects and the imaging data were used to assess the fusion of vertebral body. All operations were successful, with operation time of (176.00±20.76) min, and the intraoperative blood loss of (155.00±30.56) ml. The patients were followed up for 12 to 18 (14.69±4.78) months. The VAS and JOA scores at 1 week after operation and at the final follow up were significantly improved (P<0.01). The improvement rate of JOA in the final follow-up was 94%. The erythrocyte sedimentation rate and C-reactive protein were reduced to normal level in all patients, and the bone grafting got fusion. There were 7 cases of positive bacterial culture and 5 cases of negative. Debridement, autogenous bone grafting and minimally invasive transforaminal lumbar interbody fusion via Quadrant invasive system combined with percutaneous short segmental vertebral fixation is a safe, clinically reliable, minimally invasive surgical procedure for the treatment of non specific lumbar intervertebral space infections.