Treatment for thoracolumbar spine infection without removing internal fixation / 中国组织工程研究

ABSTRACT

BACKGROUND:Surgical site infection of instrumented thoracolumbar spine is not rare and may induce serious consequences. There’s controversy about whether to remove the internal fixation in the treatment of infection. OBJECTIVE: To evaluate the safety of the treatment for surgical site infection of thoracolumbar spine without removing internal fixation. METHODS:A total of 358 patients underwent thoracolumbar internal fixation in Department of Orthopedics, the Fourth People’s Hospital of Zigong City, between March 2008 and December 2012. Among them, 13 cases appeared surgical site infection of instrumented thoracolumbar spine, including 5 males and 8 females. The average age of the 13 cases was 54.5 years (31-65 years). After patients were treated with aggressive debridement, irrigation and anti-infective therapy, the wound healings were evaluated. The hemanalysis, erythrocyte sedimentation rate, C-reactive protein and visual analogous scale score were analyzed and compared before debridement and 6 months after debridement. RESULTS AND CONCLUSION: The 13 patients had surgical site infection of instrumented thoracolumbar spine during 1 to 13 months post-operation. After timely diagnosis, aggressive debridement and irrigation, as wel as sensitive antibiotic therapy, 12 patients succeeded in curing infection and retaining implants. 1 patient with T12 fracture removed the fixation and cured infection. The folow-up time was 8-40 months, no case recurred. The hemanalysis, erythrocyte sedimentation rate, C-reactive protein and visual analogous scale score showed significant difference before debridement and 6 months after debridement (P < 0.05). Postoperative infection after thoracolumbar internal fixation should be timely diagnosis and receive surgical treatment. Through aggressive debridement, irrigation and sensitive antibiotic therapy, most patients can be cured without removing internal fixation.