Surgical Treatment Options And Efficacy Analysis Of Pyogenic Spondylitis

Objective To investigate surgical selections and the clinical efficacy of surgical treatment of pyogenic spondylitis.Methods Retrospective analysis of data of 83 patients with pyogenic spondylitis who underwent surgical treatment from November 2013 to January 2021.Different surgical approaches were selected according to the site of infection,the degree of destruction of vertebral and nerve compression,including 14 cases of anterior approach,60 cases of posterior approach,and 9 cases of combined anterior and posterior approach.The hospitalization time,operation time,intraoperative blood loss,and complications were recorded.White blood cell count(WBC),erythrocyte sedimentation rate(ESR),and C-reactive protein(CRP)were compared before operation,1,3 months after operation,and the final follow-up.The degree of pain was assessed using the visual analogue scale of pain(VAS)score,and the functional status of the spinal cord was assessed by the American Spinal Injury Association(ASIA)classification.All operations were successfully completed,except for one patient who died,and the rest of the patients were followed up for 12 to 46 months with an average of 25.1 months.Results The hospitalization time was 6～30(18.11 ± 8.01)days,the operation time was 45～345(151.67± 58.82)minutes,and the intraoperative blood loss was 50～1200m L,the median and interquartile range were 200(IQR:100～350)m L.All patients were treated with intravenous antibiotics for(2.93 ± 1.56)weeks and then switched to oral antibiotics for(6.39 ± 2.08)weeks.A total of 51 patients underwent bacterial culture,of which 34 cases were detected pathogens,the positive rate was 66.6 %.The WBC,ESR,CRP,and VAS scores at each time point after operation decreased gradually with the prolongation of follow-up time,and the differences were statistically significant(P < 0.05).There were 46 patients with spinal neurological deficit before operation,and except for 1 patient with ASIA Grade A died,the ASIA grade of the other patients was improved compared with that before operation.Conclusions Pyogenic spondylitis in grasping the premise of surgical indications to select the suitable surgical approach can completely remove the lesion,bone graft reconstruction,correction of deformity,and supplemented with anti-infection treatment,which can achieve good results with a low recurrence rate and good prognosis for the patient.