微创侧入路腰椎椎间融合联合后路内固定治疗腰椎间隙感染

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Abstract Objective To evaluate effect of minimally invasive extreme lateral interbody fusion (XLIF) combined with posterior percutaneous pedicle screw fixation in the treatment of pyogenic lumbar intervertebral infection.Methods 20 cases with pyogenic lumbar intervertebral space infection who underwent surgery with XLIFtechnique and posterior percutaneous pedicle screw fixation were included in the study from January 2012 to December 2018 in our hospital.Their data about operative time，estimate blood loss，length of stay，bone fusion state，kyphosis and sagittal balance correction，clinical and radiographic characteristics were retrospectively collected and analyzed.Results Twenty consecutive cases (were reviewed，with mean age of 54.9 years old (18~67)and 18.9 months (11~56)follow-up duration.There were 23 operative levels analyzed in this study.The mean operative time was (279.6±73.9)minutes per segment，and estimate blood loss (241.3±70.1)mL，with mean postoperative length of stay (4.4±2.8)days.At the final follow-up，11 to 56 months postoperatively，back pain visual analogue scores (VAS) and Oswestry disability index (ODI) were significantly reduced (9.30±1.63% vs 0.65±0.49 and 77.65±9.41% vs 6.60±1.05 respectively) compared to preoperative values(P＜0.05).Lumbar lordosis increased 6.12° (14.7%) (P＜0.05)and segmental kyphosis reduced 1.99° (－21.6%) (P＜0.05) postoperatively which demonstrated sagittal balance maintained and kyphotic deformity corrected effectively.Moreover，indirect decompression indexes including intervertebral space height，foraminal height，foraminal area，spinal canal cross sectional area (CSA) and central sagittal diameter were significantly improved postoperatively(P＜0.05).Bone fusions were verified radiographically in all cases at the final follow-up.All the patients showed neurological recovery and no reoperation was needed and no recurrence of infection.Conclusion Minimally invasive XLIF technique combined with posterior percutaneous pedicle screw fixation showed merits of debridement completely，keeping spine stability effectively and improved clinical and radiographic parameters in proper selected pyogenic lumbar intervertebral infection cases.

Key words： lumbar intervertebral space infection minimally invasive surgery extreme lateral interbody fusion percutaneous pedicle screw fixation

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