Guo Yanjiang, Yang Yunbo, Chen Zan, Feng Daxiong, Lei Fei
Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No.25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, PR China.
J Orthop Surg Res. 2025 Apr 1;20(1):330. doi: 10.1186/s13018-025-05735-x.
Surgical treatment of suppurative spondylitis requires focus debridement, spinal stability, and deformity correction. Different approaches face challenges like complex anatomical structures and greater trauma. The aim is to evaluate the clinical efficacy of One-stage debridement approach combined with autogenous bone grafting and internal fixation for the treatment of adult thoracic or lumbar suppurative spondylitis via the multifidus and longissimus interspaces.
From July 2018 to July 2021, 91 patients (65 male, 26 female) with single - level thoracic or lumbar suppurative spondylitis underwent the one-stage posterior procedure. Operative details and hospital stay were recorded. ESR, CRP, and PCT levels were analyzed at specific times. Pain was rated by VAS, Using ODI score to evaluate the improvement of lumbar activity, and neurological function was assessed by ASIA scale. Cobb angles were measured for deformity evaluation. Bony fusion was evaluated by radiography and computed tomography.
The mean operative duration was 195.6 ± 15.4 min, blood loss was 575.9 ± 90.1 ml, and hospital stay was 19.9 ± 2.2 days. ESR, CRP, and PCT levels significantly decreased before discharge (ESR: 80.2 ± 14.6 mm/h vs. 30.2 ± 8.9 mm/h, CRP: 58.5 ± 13.6 mg/L vs. 15.1 ± 7.4 mg/L, PCT: 0.8 ± 0.2 ng/ml vs. 0.1 ± 0.1 ng/ml, P < 0.05). All patients had pain relief. VAS scores improved (preoperative 7.7 ± 1.1, before discharge 2.8 ± 0.6, final follow-up 1.3 ± 0.6). The lumbar activity of all patients was significantly improved compared with preoperative(preoperative 41.36 ± 3.20, final follow-up 6.18 ± 1.33). Neurologically impaired patients improved in ASIA grade. The mean preoperative Cobb angle was 19.6 ± 1.6°, reduced to 6.2 ± 1.5° before discharge and 9.4 ± 1.0° at final follow-up. The mean angle correction was 13.4 ± 0.6°, correction rate 68.7% ± 5.4% (P < 0.05), with a final loss angle of 3.2 ± 0.7° and loss rate 24.1% ± 4.8%. All grafts achieved complete fusion.
This one-stage posterior approach is effective and feasible for adult single - level thoracic or lumbar suppurative spondylitis, protecting paravertebral muscles and posterior ligament complexes. However, further studies with larger samples and longer follow-up are needed.
化脓性脊柱炎的手术治疗需要病灶清除、脊柱稳定和畸形矫正。不同的手术入路面临着诸如解剖结构复杂和创伤较大等挑战。目的是评估经多裂肌和最长肌间隙一期病灶清除联合自体骨移植及内固定治疗成人胸腰椎化脓性脊柱炎的临床疗效。
2018年7月至2021年7月，91例单节段胸腰椎化脓性脊柱炎患者接受了一期后路手术。记录手术细节和住院时间。在特定时间分析血沉（ESR）、C反应蛋白（CRP）和降钙素原（PCT）水平。采用视觉模拟评分法（VAS）评估疼痛程度，采用Oswestry功能障碍指数（ODI）评分评估腰椎活动度改善情况，采用美国脊髓损伤协会（ASIA）分级评估神经功能。测量Cobb角以评估畸形情况。通过X线和计算机断层扫描评估植骨融合情况。
平均手术时间为195.6±15.4分钟，出血量为575.9±90.1毫升，住院时间为19.9±2.2天。出院前ESR、CRP和PCT水平显著下降（ESR：80.2±14.6毫米/小时 vs. 30.2±8.9毫米/小时，CRP：58.5±13.6毫克/升 vs. 15.1±7.4毫克/升，PCT：0.8±0.2纳克/毫升 vs. 0.1±0.1纳克/毫升，P<0.05）。所有患者疼痛均缓解。VAS评分改善（术前7.7±1.1，出院前2.8±0.6，末次随访1.3±０.6）。所有患者的腰椎活动度较术前均显著改善（术前41.36±3.20，末次随访6.18±1.33）。神经功能受损患者的ASIA分级改善。术前平均Cobb角为19.6±1.6°，出院前降至6.2±1.5°，末次随访时为9.4±1.0°。平均角度矫正为13.4±0.6°，矫正率68.7%±5.4%（P<0.05），最终丢失角度为3.2±0.7°，丢失率24.1%±4.8%。所有植骨均实现完全融合。
这种一期后路手术方法治疗成人单节段胸腰椎化脓性脊柱炎有效且可行，可保护椎旁肌和后韧带复合体。然而，需要更大样本量和更长随访时间的进一步研究。
