Intervertebral Space Infection Research Articles

Clinical manifestation and treatment strategy of intervertebral space infection after radiofrequency ablation of lumbar nucleus pulposus

To study the clinical manifestations and treatment of intervertebral space infection after percutaneous lumbar radiofrequency ablation of nucleus pulposus. A retrospective analysis was performed of 496 patients who underwent percutaneous lumbar disc decompression using low-temperature plasma radiofrequency ablation nucleus pulposus from June 2009 to June 2019. Six patients had lumbar infection, and the infection rate was 1.21%. All patients were male, ranging in age from 20 to 61 years old. Three patients underwent single segment radiofrequency ablation, two patients underwent dual segments ablation;and one patient underwent three segment ablation, totaling 10 intervertebral discs. One patient was complicated with type 2 diabetes before operation. The interval between infection occurrence ranged from 21 to 65 days. All 6 patients were followed up, and the duration ranged from 18 to 40 months, with an average of 24 months. Among them, 2 patients presented with symptoms of low back pain accompanied by fever, and imaging examination showed intervertebral space infection accompanied by abscess. In addition, 4 patients experienced low back pain but no fever, and MRI showed abnormal signals of the infected intervertebral endplate or vertebral body. One patient showed staphylococcus aureus in blood culture, while the remaining 5 patients showed negative bacterial culture. All the patients were treated with antibiotics after diagnosis. Four patients were treated with conservative management to control infection;1 patient was treated with debridement of posterior lumbar infection focus, and 1 patient was treated with debridement of posterior lumbar infection focus combined with interbody fusion and internal fixation. The occurrence of intervertebral space infection during lumbar radiofrequency ablation nucleoplasty should be given sufficient attention. Strict aseptic technique, avoiding repeated multi segment puncture, realizing early detection and treatment, and selecting appropriate treatment methods according to the severity of infection is the guarantee of achieving curative effect.

Effect of Collagenase Chemonucleolysis on Residual Pain After Transforaminal Lumbar Endoscopic Discectomy.

To investigate the short-term clinical effect of collagenase chemonucleolysis (CCNL) in the treatment of residual pain after transforaminal lumbar endoscopic discectomy (TLED). The clinical data of 40 patients with residual pain after TLED for lumbar disc herniation (LDH) in our hospital from January 2018 to December 2020 were retrospectively analyzed. The visual analogue scale (VAS) and quality of recovery-15 (QoR-15) were used to evaluate the effect of the operation. Modified MacNab method was used to evaluate the efficacy of CCNL at 6 months and 12 months after operation. All patients successfully completed the operation without serious complications, such as intervertebral space infection, vascular injury and nerve injury. The VAS 3 days after TLED was not significantly lower than that Pre-TLED (P > 0.05). The VAS at each time point after CCNL was significantly lower than that at Pre-TLED, and the QoR-15 score at each time point after CCNL was significantly higher than that 3 days after CCNL (P < 0.05). The modified MacNab criteria for the last follow-up was 95%. CCNL can effectively relieve the residual pain after TLED, and the quality of life of patients after TLED is improved with time, and the safety of CCNL is higher.

Clinical Analysis of Intervertebral Space Infection after Operative Treatment of Lumbar Disc Herniation

Clinical Analysis of Intervertebral Space Infection after Operative Treatment of Lumbar Disc Herniation

Treatment of upper lumbar disc herniation with percutaneous endoscopic lumbar discectomy through two different approaches

To explore clinical efficacy of percutaneous endoscopic lumbar discectomy through two different approaches in treating upper lumbar disc herniation. From March 2015 to August 2019, 32 patients with upper lumbar disc herniation treated by percutaneous endoscopic lumbar dicecromy(PELD) were analyzed retrospectively and divided into percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) group according to different methods. There were 19 patients in PETD group, including 10 males and 9 females aged from 30 to 65 years old with an average of (44.70±12.08) years old;5 patients on L1, 2, 6 patients on L2, 3, 8 patients on L3, 4;6 patients were central herniation, 8 patients were paracentric herniation, and 5 patients were migration of herniation. There were 13 patients in PEID group, including 4 males and 9 females aged from 25 to 55 years old with an average of (42.23±12.09) years old;the courses of disease ranged from 1 to 7 months with an average of (2.90±3.02) months;3 patients on L1, 2, 4 patients on L2, 3, 6 patients on L3, 4;2 patients were central herniation, 4 patients were paracentric herniation, 3 patients were migration of herniation, 4 patients were prolapse free type protrusion. VAS and ODI score before operation, postoperative at 3 days, 3 and 6 months were compared between two groups, advanced MacNab standard at 1 year after operation were applied to evaluate clinical effects. Operation were successful operated in 32 patients and obtained following up without nerve injury and infection of intervertebral space. One patient in PETD groups occurred dural sac tear in operation, but no adverse reaction afteroperation. PETD group was followed up from 12 to 24 months with an average of (15.80±3.48) months, while PEID group was followed up from 12 to 30 months with an average of (16.70±4.66) months, while there was no statistical difference between two groups (P>0.05). VAS and ODI score at different time points after operation were higher than that of before operation (P<0.05). According to advanced MacNab standard at 1 year after operation, 11 patients obtained excellent results, 6 good, 1 moderate and 1 poor in PETD group;while 7 patients got excellent results, 4 good, 2 moderate in PEID group. Both of two surgical approach could achieve satisfactory efficacy in treating upper lumbar disc herniation, PETD is more suitable for central herniation, paracentric herniation and patients with mild displacement, PEID has advantage on prolapse free type protrusion.

Clinical efficacy of endoscopy in the treatment of lumbar disc herniation combined with posterior apophyseal ring separation

To investigate the efficacy and safety of total spine endoscopy in the treatment of lumbar disc herniation combined with posterior apophyseal ring separation. From January 2015 to January 2018, a total of 21 patients with lumbar disc herniation complicated with posterior apophyseal ring separation were treated with total spine endoscopy via interlamina approach. There were 17 males and 4 females. The age ranged from 18 to 48 years old and the median age was 27 years old. All were single segment unilateral disc herniation, interlaminar approach was adopted, and the herniated disc was removed unilaterally at the symptomatic side under the microscope, and all or part of the broken bonewas removed. There were no complications such as incision infection, intervertebral space infection, intestinal injury, dural injury and cerebrospinal fluid leakage. The operation time ranged from 32 to 92 minutes and the median time was 57 minutes. Postoperative imaging examination showed that 2 patients had complete resection of osteotomy of posterior edge of vertebral body, 16 patients had partially resection and 3 patients had no resection. All intervertebral discs were completely removed. All 21 patients were followed up, and the duration ranged from 12 to 36 months, with a median of 15 months. The VAS of lumbago was 7.10±1.20 before surgery, 3.46±0.23 on the 3rd day after surgery, 2.36±0.19 on the 6th month after surgery; and the VAS of leg pain was 8.80±0.55 before surgery, 3.54±0.28 on the 3rd day after surgery, and 2.59±0.26 on the 6th month after surgery. The Oswestry Disability Index score was (69.71±9.37)% before surgery, (32.19±6.95)% on the 6th month after surgery, and (20.95± 6.16)% at the latest follow up. Onthe 1st year after operation, 16 patients got an excellent result, 4 good and 1 fair according to Macnab evaluation system. Total spine endoscopy via interlaminal approach can be used as an option in the treatment of lumbar disc herniation combined with vertebral posterior margin dissociation, which can reduce trauma and injury to the lumbar dorsal muscle and achieve similar decompression effect as open surgery. The long term efficacy needs to be further proved by prospective randomized controlled studies with larger sample size.

Oblique Lumbar Interbody Fusion with Stand-Alone Cages for the Treatment of Degenerative Lumbar Spondylolisthesis: A Retrospective Study with 1-Year Follow-Up.

Patients with degenerative lumbar spondylolisthesis (DLS) often suffer from years of low back pain (LBP) due to instability of the lumbar spine and the reduction of disc height. Since January 2016, we have performed oblique lateral interbody fusion (OLIF) on 154 patients. Among these, 56 patients who suffered from DLS underwent OLIF with stand-alone cages. Forty-two patients with a follow-up time that exceeded 1-year were enrolled for this study. The forty-two patients were followed up for at least one year. Operation segments ranged from L3-4 to L4-5. All the patients were with 1-level fusion. The mean postoperative ventral-disc height and dorsal-disc height increased significantly compared with preoperative (P < 0.05). A significant postoperative increase was also observed in the mean operative segmental lordotic angle and the whole lumbar lordotic angle (P < 0.05). Compared with preoperative, the postoperative VAS significantly decreased with no significant increase in the VAS in the last follow-up. The LBP was significantly relieved. The mean postoperative VAS of LBP decreased significantly compared with the preoperative ((1.6 ± 0.8) vs. (7.8 ± 0.8)). Postoperative complications included psoas major abscess and intervertebral space infection (1/56). Except for one patient whose cage subsided during the last follow-up, the other patients had good cage position. The one whose cage collapsed complained no symptoms including LBP. OLIF with stand-alone cages should be considered as a safe and effective option which can effectively alleviate LBP for the treatment of DLS.

Spinal endoscopy via percutaneous transforaminal approach for lumbar posterior ring apophysis separation

Objective To investigate the clinical efficacy of spinal endoscopic surgery for lumbar posterior ring apophysis separation (PRAS) via percutaneous transforaminal approach. Methods A retrospective case series study was conducted to analyze the clinical data of 32 patients with lumbar PRAS admitted to the First Affiliated Hospital of Fujian Medical University from September 2016 to March 2018. There were 20 males and 12 females, aged 20-47 years [(33.7 ± 6.6)years]. All patients had single-segment lesions. The injured segments were at L3/4 in seven patients, L4/5 in 14 patients, L5/S1 in 11 patients. All patients were treated with spinal endoscopic surgery via percutaneous transforaminal approach. The incision length, operation time, intraoperative blood loss, intraoperative fluoroscopy times of C-arm X-ray machine and operational complications were recorded. At 24 hours, 3 months and 12 months after operation, the efficacy was evaluated by visual analogue score (VAS), Oswestry dysfunction index (ODI) and modified MacNab criteria. Results All patients were followed up for 12-30 months, with an average of 15.5 months. The incision length was 7-9.5 mm [(8.0±0.9)mm], the average operation time was 60-155 minutes [(80.5±13.2) minutes], the average intraoperative blood loss was 5-25 ml [(10.6±5.7)ml] and the average number of fluoroscopy was 5-25 times [(9.4±3.4) times]. The patients were permitted to move wearing hard waist 8-12 hours after operation and returned to normal work and life 6 weeks after operation. Postoperative dysesthesia was noted in one patient, who recovered after neurotrophy and physiotherapy after one week. There were no complications such as open surgery conversion, intervertebral space infection, nerve root injury and dural sac laceration. The VAS and ODI at 24 hours, 3 months and 12 months after operation [low back pain VAS: (3.4±1.5)point, (1.8±1.1)points, (1.7±0.9)points; leg pain VAS: (1.8±1.0)points, (1.6±0.8)points, (1.4±0.6)points; ODI: (26.8±9.7)%, (13.9±4.3)%, (12.8±2.8)%] were significantly improved compared with those before operation [ back pain VAS: (7.3±2.1)points, leg pain VAS: (7.9±2.7)points; ODI: (56.2±15.6)%] (P<0.05). According to the modified MacNab criteria, the results were excellent in 25 patients, good in five patients, and fair in two patients, with the excellent and good rate of 94%. Conclusion Spinal endoscopic surgery for lumbar PRAS via percutaneous transforaminal approach is an effective method with advantages of small incision, less complications, effective pain relief and fast functional recovery. Key words: Lumbar vertebrae; Endoscopy; Surgical procedures, minimally invasive

Retrospective study of the interlaminar approach for percutaneous endoscopic lumbar discectomy with the guidance of pre-operative magnetic resonance neurography.

To measure the direct effects of pre-operative magnetic resonance neurography (MRN), and analyze the procedure and clinical outcomes of the percutaneous endoscopic interlaminar discectomy, in order to demonstrate the feasibility and safety of the interlaminar approach. In this study, 127 patients who underwent percutaneous endoscopic lumbar discectomy (PELD) and were followed up by more than 12 months, were retrospectively evaluated. The pre-operative demographic data were collected. In addition, the coronal scan and the reconstruction of the lumbosacral plexus were examined to measure the distance between the nerve root and the dural sac at the coronal plane. Furthermore, the post-operative and pre-operative visual analog scale (VAS) scores and Oswestry Disability Index (ODI) were compared. The mean and minimum values of distance T between the nerve root and dural sac of L5/S1 to L2/3 on the operation side of the MRN images were all larger than 7.3 mm which is the diameter of the working canal. During the follow-up, VAS and ODI data improved significantly compared with their corresponding pre-operative scores (P<0.01). Regarding the post-operative complications, there were 2 (1.57%) cases of hypesthesia and 3 (2.36%) cases of neuropathic pain, which were transient and alleviated in 3 months. In addition, there was 1 (0.79%) case of intervertebral space infection and 1 (0.79%) dural tear. No relapse of disc herniation and iatrogenic instability occurred by the end of the last follow-up. The MRN indicates that the incidence of herniated disc impingement increases over the distance between the nerve root and the dural sac, thus making the interlaminar approach more suitable for the treatment of herniation. The procedures and clinical outcomes of the IL-PELD demonstrate the safety and advantages of the interlaminar approach.

Effect and effectiveness analysis of different approaches of transforaminal endoscope on extirpation amount of nuclues pulposus

To investigate the effect and effectiveness analysis of different approaches of transforaminal endoscope on extirpation amount of nuclues pulposus. Between August 2011 and December 2014, a total of 165 patients with lumbar disc herniation were retrospectively enrolled and were treated with nucleus pulposus discectomy through transforaminal endoscope. The patients were randomly divided into 4 groups according to different approach of transforaminal endoscope. The posterolateral approach (Yeung's technology) was used in group A (42 cases), transforaminal endoscopic spine system (TESSYS) technology was used in group B (40 cases), improved transforaminal endoscopic access (ITEA) technology was used in group C (43 cases), and interlaminar approach (40 cases) was used in group D (40 cases). There was no significant difference in gender, age, disease duration, symptomatic side, and segments among 4 groups ( P>0.05). The extirpation amount of nuclues pulposus was calculated and compared among 4 groups; the effectiveness was evaluated by pre- and post-operative visual analogue scale (VAS) score, Oswestry disability index (ODI), lumbar curvature index (LCI), and intervertebral height. The discectomy amount of nucleus pulposus was (3.7±0.8), (3.6±0.7), (4.5±1.1), and (3.0±0.8) cm 3 in groups A, B, C, and D, respectively. The amount of group C was significantly larger than that of the other 3 groups ( P<0.05), and the amount of group D was significantly smaller than that of the other 3 groups ( P<0.05); no significant difference was found between groups A and B ( P>0.05). Cerebrospinal fluid leakage was found in 1 case; no other postoperative complications including intervertebral space infection and epidural hematoma was found. All the incisions healed by first intension. All the patients were followed up 12-24 months (mean, 18 months), and no typical symptoms of recurrence was found during the follow-up period. There was no significant difference in preoperative lower back pain VAS score, lower extremities VAS score, and ODI scores among 4 groups ( P>0.05). The above scores at last follow-up were significantly improved when compared with preoperative ones in each group ( P<0.05), but no significant difference of above scores and recovery values was found among 4 groups ( P>0.05). The difference in LCI and intervertebral height at preoperation and at last follow-up were not significant between 4 groups ( P>0.05). The difference in LCI and intervertebral height of each group between at preoperation and last follow-up were not significant ( P>0.05). And the recovery value of LCI and the lost of height at last follow-up also showed no significant differences between 4 groups ( P>0.05). The ITEA technology can give a wider field of view than other technologies. It is more convenient to find and remove the nucleus pulposus. However, the appropriate operative approaches should be chosen according to the symptoms and characteristics of lumbar disc herniation.

Application of broad easy immediate surgery in percutaneous transforaminal endoscopic technology for lumbar lateral recess stenosis in the elderly

To explore the safety and effectiveness of percutaneous transforaminal endoscopic BEIS technology for lumbar lateral recess stenosis in the elderly. From February 2014 to May 2016, 21 patients with lumbar lateral recess stenosis in elderly were treated with percutaneous endoscopic BEIS. There were 13 males and 8 females, aged from 70 to 85 years old with an average of 74.3 years. Preoperative, 1 and 12 months postoperative visual analogue scale(VAS) scores and Oswestry Disability Index(ODI) were statistically analyzed. MacNab was used to assess the clinical effects. All the operations were successful. The time ranged from 90 to 130 min with an average of 110 min. All the patients were followed up for 12 to 38 months with an average of 18 months. Preoperative, 1 and 12 months postoperative VAS scores were 8.47±1.23, 1.78±0.72, 0.68±0.32, and ODI scores were 32.48±10.03, 19.53±3.55, and 5.15±1.02, respectively. Postoperative scores of VAS and ODI were obviously improved(P<0.05). According to modified MacNab standard to evaluate the clinical effects, 14 cases obtained excellent results, 5 good, 2 fair. Lower limb paresthesia occurred in 1 case, and the condition was restored at 3 months postoperatively with conservative treatment. One patient was complicated with emphysema before operation secondary to pulmonary infection, and was effectively controlled with regulate antibiotic therapy. No infection of vertebral body or intervertebral space, no injuries of blood vessels or nerve root, no tear of dura, or the leakage of cerebrospinal fluid were found. Percutaneous transforaminal endoscopic BEIS is a safe and effective method for lumbar lateral recess stenosis in the elderly.

Observation of clinical effects of radiofrequency ablation in the treatment of cervical spondylotic radiculopathy

Objective To compare the clinical effects of conservative therapy and radiofrequency ablation in the treatment of cervical spondylotic radiculopathy, to analyze the reason and discuss the surgical indications. Methods Fifty-five patients with cervical spondylotic radiculopathy treated in Shijingshan Hospital from May 2013 to May 2016 were selected and retrospectively analyzed, including 30 patients received conservative treatment (conservative group), 25 patients undergone radiofrequency ablation (operation group). Visual analogue score (VAS) was used to assess the degree of pain relief in the two groups before treatment and 1 week, 1 month after treatment.The side effects in the two groups and the postoperative complications of the patients were observed. Results The VAS score of the operation group and the conservative group in 1 weeks after treatment were (3.2±0.5) points, (5.2±0.7)) points, 1 months (2.8±0.3) points, (5.8±0.4) points, respectively, the degree of pain were lower than those collected before treatment (8.0±0.9) points, (7.6±0.8) points, separately, the differences were statistically significant (P<0.05), and the degree of pain relief in the operation group was more obvious than that in the conservative group, there was significant difference between the two groups (P<0.01). Two groups of patients were treated with medication without any obvious discomfort.The surgery of the operation group was successful, and no complications such as nerve and spinal cord injury, vascular injury, local hematoma, puncture needle breakage and intervertebral space infection were found. Conclusion Radiofrequency ablation is more effective for the treatment of cervical spondylotic myelopathy in the short term than conservative treatment, and radiofrequency ablation treatment is a recommended choice for patients with no surgical contradiction. Key words: Cervical spondylosis; Minimally invasive; Radiofrequency ablation

Clinical research on the accuracy of cervical pedicle screws

Objective To evaluate the clinical effect of a self-developed technique of manual placement of pedicle screw in cervical spine based on anatomical research. Methods Data of 105 patients who had cervical pedicle screw placement within seven years (from April 2007 to April 2013, and April 2013 to April 2016) were retrospectively analyzed, including 60 male and 45 female, aged from 20 to 76 years (51.7±14.5 years). Five main types of spinal injury were included: traumatic spinal injury (61 cases), degenerative cervical injury (19 cases including 12 ossification of posterior longitudinal ligament and 7 cervical spondylosis), cervical cancer (16 cases including 9 schwannoma, 4 meningioma, and 3 cases of cervical vertebral tumor), cervical deformity (6 cases including 3 kyphosis and 3 congenital malformation), and intervertebral space infection (3 cases). All the patients had X-ray, CT scan and MRI imaging pre-operatively, and X-ray and CT scan were also performed post-operatively to assess the accuracy of the position of screws. The accuracy of pedicle screws placement and screw leaning degree were analyzed according to the Lee standard. Grade 0: no penetration; Grade I: pedicle penetration within 25% of the pedical screw diameter; Grade II: pedicle penetration between 25% to 50% of the pedical screw diameter; Grade III: pedicle penetration beyond 50% of the pedical screw diameter. Grade II and III were considered as misplacement. In patients of Grade II and/or III, complications of blood vessels and nerve injury, etc. were observed. American spinal injury association (ASIA) was used to classify spinal injury among patients with trauma, while Japanese Orthopaedic Association Scores (JOA) was used to evaluate neural function improvement within patients without trauma. Results A total of 510 screws were placed by manual placement in 105 patients. Among 99 valid patients (6 without post-operative CT scan were excluded) with 497 screws (including 201 in upper cervical spine, and 296 in lower cervical spine), the results were shown as following: (1) Screw placement accuracy: 486 screws of Grade 0, 8 screws of Grade I, 3 screws of grade II, and 0 screws of Grade III. (2) 11 screws were penetrated pedical cortex with 8 of Grade I and 3 of Grade II (2 penetrated into cortical paries medialis and 1 penetrated into paries lateralis, but no screw penetrated into upper or inferior border). The accuracy of screw placement was 97.79% (Grade 0), the total misplacement rate was 0.6% (Grade II and III). According to post-operative follow up in 12 to 30 months (average 20.6±5.2 months), no complication of spinal, nerve root, or vascular injury was found. No screw loosening or fracture occurred, and all bones were healed properly. Follow up in the 6 months after operation showed that patients with trauma had significantly improvement in ASIA grading, while patients without trauma had better JOA scores. Conclusion Based on the study, the technique of manual placement of pedicle screw in cervical spine is considered to be safe and reliable. Considering its wide indication, it’s a technique worthy of clinical application. Key words: Cervical vertebrae; Spinal fusion; Bone screws; Tomography, X-ray computed

Anterior debridement bone graft fusion and posterior fixation in treatment of intervertebral infection

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. Key words: Lumbar vertebrae; Infection, intervertebral space; Fusion; Internal fixation

Modified transforaminal lumbar interbody fusion for acute and chronic lumbar intervertebral disc injury via minimally invasive expandable access system

Objective To evaluate outcomes of modified transforaminal lumbar interbody fusion (TLIF) assisted by the minimally invasive expandable access system and spinal channel endoscope for acute and chronic lumbar intervertebral disc injury. Methods From March 2013 to November 2014, 45 patients with lumbar intervertebral disc injury were managed with minimally invasive (Group A) or open TLIF (Group B). Location for disc injury was at L3/4 in 5 patients, L4/5 in 28 patients and L5-S1 in 12 patients. Group A composing 12 males and 10 females showed age of (53.70±3.59) years (range, 43 to 67 years). Group B composing 14 males and 9 females showed age of (54.80±4.37)years (range, 42 to 68 years). Between-group comparison was conducted with respect to operation time, blood loss, postoperative drainage loss, ambulation time and postoperative complications. Clinical outcomes were evaluated using the visual analogue scale (VAS), Oswestry dysfunction index (ODI), and bone fusion rate. Results Except for the comparable operation time, group A was associated with better results in the blood loss [(152.1±15.5)ml vs (409.9±28.3)ml], drainage volume[(106.1±14.3)ml vs (223.0±19.4)ml], ambulation time[(4.5±1.1)d vs (8.9±1.4)d] and 1-week postoperative VAS [(3.0±0.7) points vs (4.7±0.4) points](P 0.05). Bone fusion rate in Group A was 95% (21/22) versus 96% (22/23) in Group B 6-month postoperatively (P>0.05). No nerve root injury, intervertebral space infection or other complications occurred. Conclusion Modified TLIF assisted by the minimally invasive expandable access system offers the benefits of less trauma, less bleeding and a quicker recovery for acute and chronic lumbar intervertebral disc injury and has similar long-term clinical outcomes with open TLIF. Key words: Intervertebral disc; Lumbar vertebrae; Endoscopes; Transforaminal lumbar interbody fusion

Clinical report of Brucella spondylitis in elderly people

Objective To discuss the clinical features and treatment of Brucella spondylitis in elderly people and its efficacy. Methods From January 2002 to May 2013, 45 cases of elderly patients with Brucella spondylitis who were misdiagnosed as spinal tuberculosis before admission were diagnosed synthetically by epidemiological history, clinical manifestations, laboratory tests, medical imaging and pathological data after admission. All patients were treated by standardized drug treatment and hyperbaric oxygen therapy, of which 19 cases were treated by non-surgical treatment (group A) and 26 cases were treated by the operation of primary debridement and posterior pedicle screw fixation (group B). All patients underwent follow-up, pain score, laboratory testing, imaging score and clinical efficacy evaluation after the operation. Results During 12 months follow-up after treatment, 17 cases were cured, 2 cases improved; no adverse drug reaction and abnormal liver and kidney function were found in group A. 26 cases in group B underwent operation, of which 24 cases were cured, 2 cases improved. The implanted bone was healed, the spine was stable and no broken nails, broken rod, recurrence and sinus formation were found in group B. Both of the treatments could gradually decrease pain score that relieved pain effectively over time. The time for pain-relieving and the pain-relieving efficacy were less or better in group B than in group A (both P<0.05). The time for decreasing the serum agglutination test (SAT) titre and C-reactive protein (CRP) level, and for becoming negative of Rose Bengal Plane Test (RBPT) was less in group B than in group A. The vertebral inflammatory infiltration and infection of intervertebral space were gradually absorbed, which required a longer period of treatment in group A, and the efficacies in imaging changes at different time were less in group A than in group B (all P<0.05). The early-stage cure rate was better in group B than in group A, although both treatments had obvious effect (P<0.05). Conclusions The formulation of the diagnostic criteria of Brucella spondylitis in elderly people can improve the diagnostic rate and reduce the misdiagnosis rate. Standardized drug treatment has a better cure rate, and timely surgical intervention can improve clinical effect and has significant advantages particularly in relieving pain, stabilizing the spine, restoring nerve function and promoting early rehabilitation. Key words: Brucellosis; Spine; Inflammation

The application of C-reactive proteinin a intervertebral space infection after minimally invasive operation of prolapse of cervical and lumbar intervertebral disc

Objective To investigate the clinical significance of C-reactive protein used for identification in an early stage of the intervertebral space whether to have become infect or not after minimally invasive operation of prolapse of cervical and lumbar intervertebral disc. Methods We collect 21 patients, including 15 men and 6 women, the age group of 35 to 76 years old , and the average age of the group is 56. The equipment used is the German Roche Campus COBAS INTEGRA 400, and yuan ding supplies us with reagents. Results The leukocyte count (wbc) of 21 cases whose intervertebral space infect after minimally invasive operation are within normal range early, while C-reactive protein (ckp) is significantly higher than normal, and it is more than 40m / L. Conclusion C-reactive protein is significant for earlydiagnosis when people's intervertebral space infect after minimally invasive operation, and it can provide the follow-up clinical treatment with effective monitoring data Key words: C-restive protein; minimally invasive operation; intervertebral space infection; differen tial diagnosis