The Clinical Application Of Spinal Internal Fixation Combined With Vancomycin Bone Cement Implantment For The Treatment Of Spinal Infection

Objective: In recent years,along with the rising number of risk factors in spinal infection,its incidence is increased year by year.At present in the treatment of the spinal infection,Since it has special the lesion site,much complications and recurrence rate is high,that is a big challenge for orthopedic surgeons.Our hospital explores the therapeutic efficacy of One stage posterior debridement,bone graft fusion and spinal internal fixation combined with vancomycin bone cement implantment in the clinical treatment of spinal infection through the observation of the preoperative and postoperativ e clinical evaluation,so as to bring new concept and ideas for the treatment of spinal infection.Methods: From January 2013 to January 2016,15 patients suffering from spinal infection were enrolled in our spine surgical ward.There were 6 males and 9 females,aged 45 to 77 years(mean,59.8±9.80years).Retrospect analyzed the clinical data and imaging data of 15 patients.There were 6 cases with lower back pain,9 cases with symptoms of nerve root and 1 case with paraplegia symptoms;8 patients had different degree of fever(37.1 to 39 degrees)and for more than 38 degrees patients,blood cultures were checked;There were 12 cases with elevated white blood cell count,13 cases with erythrocyte sedimentation rate increased and 13 cases with elevated c-reactive protein;1 patient suspected of brucella bacillus infection and tiger red plate agglutination test was positive;All patients were performed X-ray,three-dimensional CT reconstruction and MRI,and there were 8 cases whose vertebral bone had obvious damage,2 cases with spinal canal epidural abscess formation,1 case who had vertebralside and(or),psoas major abscess formation;Pathological site: 2 cases of thoracic vertebra and 13 cases of lumbar vertebra.All of 15 cases accepted one stage posterior debridement and spinal internal fixation combined with vancomycin bone cement implantion treatment.It was to be the clinical evaluation standard by observing the preoperative and postoperative visual analogue scale,neurological function American spinal injury association classification and white blood cells,laboratory erythrocyte sedimentation rate,erythrocyte sedimentation,C-Reactive protein and other evaluation indexes.Results:The 15 cases of patients were followed for an average time of 13 months(12to 15 months)..As time went on,the patient's symptoms gradually relieved.The VAS scores of pain at 3 months(2.13±0.64),6 months(0.87±0.64),12 months(0.60±0.63)was significantly decreased when compared with preoperative score(5.40±1.35)(P<0.05);The nerve function ASIA classification at 3 months,6 months and12 months were significantly improved when compared with preoperative values,the differences were statistically significant(P < 0.05);The white blood cells,CRP and ESR at 10 days,3 months,6 months and 12 months were significantly declined when compared with the preoperative ones,the differences were statistically significant(P <0.05).No pedicle screw and rods losse,and no recurrence of infection and pain occurred to the end of follow-up.The bone fusion time was 7 ~ 11 months(mean,8.4 months).Conclusion: The therapeutic method which takes one stage posterior debridement,bone graft fusion and spinal internal fixation combined with vancomycin bone cement,can effectively remove the infection lesions,reconstruct the spinal stability,correct the spinal deformity and shorten the time in bed.In addition,vancomycin bone cement implantment,not only raises successful rate of the operation,but also reduces the time of systemic intravenous antibiotics,to avoid the patients systemic side effects due to long-term application of intravenous antibiotics.