前路病灶清除、异体骨植骨融合、钛板内固定治疗下颈椎感染

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Abstract

Objective To discuss the clinical efficacy of anterior debridement，allografting and titanium plate instrumentation for lower cervical spondylodiscitis.Methods 57 patients with lower cervical spondylodiscitis treated by anterior debridement，allografting and titanium plate instrumentation in our hospital from April 2011 to June 2015，including 36 cases of tuberculosis (A group)，13 cases of brucellosis (group B)，8 cases of pyogenic infections (group C).There were 32 males and 25 females，with a mean age of (53.1±7.95) years.All of the patients were followed-up at least 12 months.Now we retrospectively analyzed the collected clinical data.Clinical features of 3 kinds of cervical spondylodiscitis were discussed according to clinical manifestations，laboratory and imaging findings.Efficacy of surgery was evaluated using pre-operative and last follow-up neck pain VAS score，JOA score，Frankel grade and Cobb angle，and allogeneic bone fusion was evaluated according to Bridwell standard as well.Results All patients were successfully operated without the surgical related complications like spinal cord，nerve，blood vessel damage.The mean operative time was (102.5±28.8)min，mean blood loss was (112.2±48.7) mL，the average follow-up period was (22.7±8.1) months.At last follow-up，neck pain VAS score improved from preoperative (6.43±1.64) to (0.81±0.74)，with a improvement rate of 87.4％.Cervical JOA score improvement was excellent in 42 cases (73.7％)，good in 11 cases (19.3％)，3 cases (5.2％)，and poor in 1 (1.8％)，showing a fine rate of 93％.52 cases of fusion reached level Ⅰ according to the Bridwell fusion standard，the total effective fusion rate was 91％；Frankle grade showed that 34 cases (59.6％) combined with neurological dysfunction preoperative，including 23 cases (63.9％) in group A，6 cases (46.2％) in group B，5 cases (62.5％) in group C，at the last follow-up except 3 cases` Frankle grade improved to grade D，the other patients were back to normal.3 cases of tuberculosis group were re-operated，2 cases were due to pseudarthrosis，1 patient was due to kyphosis related neurological disorders.During the follow-up period，no one patient occurred wound infection，internal fixation or allogenic bone graft prolapse and recurrence.Conclusion For tuberculous，brucellar and pyogenic lower cervical spondylodiscitis，anterior surgery can obtain complete debridement and spinal cord decompression.The application of allogeneic bone graft and titanium plate is safe and reliable，and can improve the clinical efficacy.

Key words： lower cervical spondylodiscitis anterior approach allogeneic bone grafting titanium plate instrumentation

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