Clinical Analysis Of Posterior Intermuscular Approach Fixation Combined With Anterior Debridement In The Treatment Of Thoracolumbar Infectious Diseases

ObjectiveTo investigate the clinical efficacy of posterior intramuscular fixation combined with anterior lesion clearance in the treatment of thoracolumbar infectious diseases.MethodsA total of 23 patients with spinal infectious diseases admitted to the Second Affiliated Hospital of Nanchang University from January 2020 to January 2023 were collected,all of whom underwent thoracolumbar posterior intramuscular fixation combined with anterior lesion clearance treatment.Evaluate the clinical efficacy of anterior and posterior combined surgery for spinal infectious diseases by collecting and analyzing preoperative and postoperative inflammatory infection related indicators(ESR,CRP),imaging parameters(Cobb angle of vertebral kyphosis,intervertebral height),and VAS,JOA,and ASIA grading.ResultsThe 23 patients in this study were all complete and successfully recorded for postoperative follow-up.The postoperative follow-up time line was 6 to 24 months,with an average of 16 months.At the last follow-up,all infectious lesions in the thoracic and lumbar spine were cured and there were no recurrent cases of infection.The surgical time was 180-230 minutes,with an average time of 190 minutes.The postoperative bleeding volume was 200-400 ml,with an average bleeding of 256 ml.There was no damage to the main blood vessels and nerves during the surgery,and there were no postoperative complications.At the last follow-up after the surgery,only 4 cases had lower limb muscle strength grade IV,and the rest returned to normal.The corresponding clinical symptoms and signs were well recovered.After surgery,according to Chen’s criteria,20 cases were excellent,3 cases were good,and the excellent and good rate was 100%;After surgery,ASIA grading was performed in 4cases with D grade and 19 cases with E grade during the last follow-up.The postoperative clinical efficacy scores JOA and VAS showed significant improvement compared to preoperative,and the difference was statistically significant(P<0.05).After surgery,ESR and CRP significantly decreased at 1 and 3 months compared to before surgery,and returned to normal at 6 months and the last follow-up period,with statistically significant differences(P<0.05).The Cobb angle was 30°-41°before surgery,with an average of 34.48°±2.92°.The Cobb angle was 4°-9 °after surgery,with an average of 6.78°± 1.65°.The last follow-up of Cobb angle was 5°-10°,with an average of 7.43°±1.38°.The loss of Cobb angle at the last follow-up was less than2°after surgery.The postoperative convex Cobb angle was significantly reduced and well corrected compared to before surgery,and the difference was statistically significant(P<0.05).The preoperative intervertebral height was 2cm～2.7cm,with an average of 2.32cm±0.20 cm.The postoperative intervertebral height was4.5cm～5.0cm,with an average of 4.76cm±0.16 cm.The final follow-up of the postoperative intervertebral height was 4.1cm～4.6cm,with an average of4.29cm±0.15 cm.At the last follow-up,the loss of intervertebral height was less than1 cm compared to postoperative,and the intervertebral height recovered significantly after surgery.The vertebral bone destruction and compression deformity were significantly corrected,and the difference was statistically significant(P<0.05).In this study,all 23 patients had no recurrence of infection,no loosening or breakage of the internal fixation system,no poor fusion of bone grafts,no degree of correction of kyphosis Cobb angle,and no loss of intervertebral height.ConclusionThe clinical surgical treatment of thoracolumbar infectious diseases adopts posterior intramuscular fixation combined with anterior lesion clearance surgery.Not only can infection lesions be more thoroughly cleared,but clinical symptoms can also be significantly improved,reducing the occurrence of postoperative complications of stubborn thoracolumbar back pain.Satisfactory therapeutic effects have been achieved in correcting thoracolumbar kyphosis and restoring intervertebral height,achieving reconstruction and protection of spinal column stability,reducing deformity and disability rates,and shortening bed rest time.It is an effective method for clinical surgical treatment of thoracolumbar infectious diseases.