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Objective:To compare the clinical efficacy and safety of Shuo Tong ureteroscopy(ST-URS) and flexible ureteroscope(FURS)combined with holmium laser lithotripsy in the treatment of upper ureteral calculi with CT numerical value ≥ 1000 HU.Methods:A retrospective analysis of the clinical data of patients of upper ureteral calculi with CT numberical value≥1000 HU in the First Affiliated Hospital of Xiamen University was made from January 2018 to November 2020.There were 61 cases treated with ShuoTong ureteroscopy holmium laser lithotripsy (ST-URS group), including 45 males and 16 females, with 40 on the left and 21 on the right, age of(48.3±12.7) years, body mass index of(24.7±2.7)kg/m 2, the diameter of stone of(1.50±0.45)cm, and the CT numberical value of(1 288.8±179.0)(1 017-1 738)HU. There were 87 cases were treated with flexible ureteroscopy holmium laser lithotripsy (FURS group), including 58 males and 29 females, with 56 on the left and 31 on the right, age of(48.5±13.0) years, body mass index of(24.1±3.8)kg/m 2, the stone diameter of(1.45±0.40)cm, and the CT numberical value of(1 311.3±188.9)(1 009-1 817)HU. There were no significant differences in gender, age, body mass index, the location of stone, the diameter of stone and the CT numberical value of stone( P>0.05)between the two groups. For ST-URS group, a rigid ureteral channel sheath and standard mirror(F7.5/11.5)were placed under direct vision, exiting the standard mirror, leaving the channel sheath, inserting a lithotripsy mirror(F4.5/6.5)and a holmium laser[Power: 8-30 W(0.4-1.0 J/20-30 Hz)], and withdrawing the stone fragments after crushing the stone by "nibbling method" . For FURS group, a hard ureteroscope(F8/9.8)was used to explore the lesion side of the ureter, inserting a guide wire and placing a soft ureteral sheath, then inserting a flexible ureteroscope(F8)for holmium laser lithotripsy, and useing a stone basket to remove larger stone fragments. Ureteral stent was routinely indwelled after the operation. On the day 1 and 1 month after the operation, imaging examinations were performed to evaluate the stone-free rate. No residual stones or the diameter of stone was ≤0.4 cm and no urinary tract infection or any symptoms were defined as stone free. The operation time, blood loss, success rate of stage Ⅰ ureteral access sheath placement, incidence of postoperative complications, stone-free rate(SFR) at 1 day after operation, SFR at 1 month after operation, postoperative hospital stay and hospitalization costs were compared between the two groups. According to the size of calculi, the 2 groups were divided into 2 subgroups(≥1.5 cm and <1.5 cm)in order to make further analysis. The operation time, stone-free rate(SFR) at day 1 after operation and SFR at 1 month after operation were compared between the two groups. Results:The operation time of the ST-URS group was shorter than the FURS group(40.10 min vs. 49.43 min, P=0.020), and the incidence of postoperative complications was lower than the FURS group[3.28%(2/61)vs. 13.79%(12/87), P=0.031]. The SFR at day 1 after operation was significantly higher than the FURS group[60.7%(37/61)vs. 25.3%(22/87), P<0.01], and the hospitalization cost was lower than that of the FURS group(27 686 yuan vs. 32 281 yuan, P<0.010). There were no significant differences in the blood loss[(4.92±9.51)ml vs.(3.95±6.04)ml, P=0.452], success rate of stageⅠureteral access sheath placement[ 96.7%(59/61)vs. 96.6%(84/87), P=1.000], SFR at 1 month after operation[81.97%(50/61) vs. 75.86%(66/87), P=0.375] and postoperative hospital stay[(2.5±1.4)d vs.(2.4±0.8)d, P=0.543] between the two groups. When the size of calculi was ≥1.5cm, the operation time of the ST-URS group was shorter than the FURS group (43.67 min vs 55.00 min), the SFR at 1 day after operation was higher than the FURS group[40.00%(12/30)vs. 9.38%(3/32)], and the above differences are all statistically significant ( P<0.05). Conclusions:Compared with the FURS, for the treatment of upper ureteral calculi with CT numerical value ≥1000 HU, the ST-URS has shorter in operative time, lower in hospitalization cost and incidence of postoperative complications and higher SFR at day 1 after operation. The ST-URS is a safe and effective surgical technique, which is superior in the treatment of larger(≥1.5 cm) stones.
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Objective:To establish surgical difficulty scoring system of partial nephrectomy based on holographic imaging and explore its application value in partial nephrectomy.Methods:A total of 184 patients including 110 males and 74 females with renal tumors diagnosed as stage cT 1 to cT 2 before surgery in the First Affiliated Hospital of Xiamen University from October 2019 to January 2022 were included. Among the 184 patients, 141 patients were treated with partial nephrectomy and 43 patients were treated with radical nephrectomy (3 partial nephrectomies were finally changed to radical nephrectomies due to vascular and tumor location). 60 patients had hypertension. 24 patients had diabetes. 7 patients had hyperuricemia. The median age was 55(47, 62) years. The median BMI was 23.7(21.8, 26.4) kg/m 2. The median maximum tumor diameter was 3.9(2.9, 5.2) cm. The median preoperative eGFR was 99.7(83.4, 114.2) ml/(min·1.73m 2). The median R. E.N.A.L. score was 8(6, 9). The median PADUA score was 9(8, 10). 153 patients were diagnosed as stage cT 1 and 31 patients were diagnosed as stage cT 2. The hologram reconstruction was performed according to preoperative CT or MRI examination. The maximum diameter of the tumor in the kidney (D), the compression degree of the renal segmental vessels by tumor(C), the area of the renal sinus occupied by tumor(O) and the mass of exophytic rate(M) were comprehensively considered and finally constituted the difficulty scoring system named DCOM score for partial nephrectomy. The DCOM score divided the complexity of tumor surgery into mild (4-6 points), moderate (7-8 points) and high (≥ 9 points). Meanwhile, the MIC (surgical margins are negative, WIT is <20 min, and no major complications)was used to evaluate the overall surgical effect. The DCOM, R. E.N.A.L. and PADUA scores were performed on all patients and compared with each other to evaluate the surgical effect of DCOM score in partial nephrectomy. Results:All surgeries in this study were successfully completed, including 141 partial nephrectomies and 43 radical nephrectomies. The DCOM score was 10(9, 11) for radical nephrectomy and 6(5, 8) for partial nephrectomy, and the difference was statistically significant ( P=0.001). There were 23 patients (37.7%) in highly complex group, 39 patients (88.6%) in moderately complex group and 79 patients (100.0%) in mildly complex group underwent partial nephrectomy, respectively. According to multifactorial analysis, patients in highly and moderately complex group of DCOM score had 8.88 times ( P=0.001) and 1.76 times ( P=0.005) less reach MIC than those in mildly complex group, respectively. Patients in highly and moderately complex group of PADUA score had 4.86 times ( P=0.005)and 3.41 times ( P=0.006)less reach MIC than patients in mildly complex group of DCOM score, respectively. What’s more, patients in moderately complex group of R. E.N.A.L. score had 3.11 times ( P=0.003) less reach MIC than patients in mildly complex group of DCOM score. In the ROC curves to predict MIC achievement, the AUC values of R. E.N.A.L., PADUA and DCOM scores were 0.657, 0.655 and 0.746, respectively. Comparing:R. E.N.A.L. score with DCOM score, the AUC value was statistically significant ( P=0.025). Conclusions The surgical difficulty scoring system (DCOM score) based on holographic imaging can predict the outcome of partial nephrectomy, but further verification is needed.
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0.05).The maximum relaxant forces of vitrification and fresh arteries groups were greater than the freezing group(P 0.05).The arteries of three groups began obvious relaxant responses when sodium nitroprusside was 10-7 mol/L, and nearly reached their maximal relaxant responses when sodium nitroprusside was 10-4 mol/L.CONCLUSION:The vitrification could preserve more active smooth muscle cells of arteries than the freezing method.The norepinephrine has better effect on contraction ability of artery, which preserved in the vitrification group than the freezing group;however, there is no difference in relaxation of sodium nitroferricyanide.
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BACKGROUND: An effective preservation method must preserve the integrity of tissue structure. OBJECTIVE: To compare the effects of vitrification and cryopreservation method on the artery morphology and mechanical properties. DESIGN, TIME AND SETTING: The randomized controlled animal experiment was done at the Department of Orthopedics, General Hospital of Chinese PLA, between September 2001 and August 2004. MATERIALS: Eighteen New Zealand rabbits were randomly divided into vitrified artery group, cryopreserved artery group and fresh artery group, with 6 rabbits in each group. METHODS: Femoral arteries were removed from rabbits and put in balanced solution. Arteries in the vitrified artery group were immersed in the 25%, 50% and 100% gradient vitrified solution at 4 ℃ and then were put in liquid nitrogen. Arteries in the cryopreserved artery group were cooled from normal temperature to 0, -20, -70 ℃, and balanced for 60 minutes, then were put in liquid nitrogen. Samples were preserved in liquid nitrogen for more than 14 days. MAIN OUTCOME MEASURES: The morphology changes of preserved arteries observed through naked eye and microscope; hysteresis loop; stress relaxation; breaking strength. RESULTS: Artery structures were all preserved well in the three groups, the integrity rate of vitrified artery group was 91.67%, which was significantly better than 54.17% of cryopreserved artery group (P 0.05). CONCLUSION: There influences of vitrification and cryoprsesrvation on the artery morphology and mechanical properties were not significant, while arteries preserved by vitrification had less tissue ruptures, so vitrification is suitable for preserving long vessels.
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BACKGROUND: Carbonated hydroxyapatite cement (CHC) s a new kind of biomaterial for bone defect, which is made of powder and fluid, and can be mixed to be pasty to repair various bone defects.OBJECTIVE: To observe the improvement of vertebrae height and pain in patients with osteoporosis vertebral compression fracture (VCF) after vertebroplasty by using a new kind of bone graft biomaterial, taking CHC as the filling material to reinforce the vertebral body.DESIGN: A contrast observation trial taking patients as subjects.SETTING: Department of Orthopaedics, General Hospital of Chinese PLA.PARTICIPANTS: Totally 34 patients with thoracic or lumbar osteoporosis VCF who received the treatment in the Department of Orthopaedics, General Hospital of Chinese PLA between October 2000 and August 2003. Inclusive criteria: ①Definite diagnosis by CT; ② Informed consents were obtained from the patients. Exclusive criteria: The patients with osteoporosis vertebral compression fractures who suffered vertebral posterior wall fracture. There were 6 males and 28 females, and they were aged (72±13)years; Among the patients, 27 were diagnosed as postmenopausal osteoporosis, 1 as cortical hormone-induced osteoporosis and 6 male patients weresenile osteoporosis.METHODS: ①All the patients were randomly divided into two groups: Experimental group (n =23) and control group (n=11). All the patients were performed percutaneous operation with local anesthenia. All cases were performed percutaneous operation under local anesthesia. Under the C-arm monitored, one side pedicle puncture was performed to enter the anterior column of the involved VCF. Patients of the experimental group were filled with CHC. Patients of control group were filled with polymethyl Methacrylate (PMMA) with the same way. ② Referred to McGill-Melzack scoring. Among the scale 0-100 mm (0 was no pain, 100 was acute pain), the value indicated the painful intensity and mental assault degree. ＜ 30 scores indicated good, 30-40 basically satisfied and ≥ 50 poor .③ Referred to the method from Lee et al, the preoperative height (A1) and postoperative height (A2) of compression fracture position of VCF were measured according to the lateral X-ray film. At the same time, the upper vertebral height (A3) and the inferior vertebral height (A4) were measured at the same position. The original height (A) of the involved vertebra was calculated as (A)= (A3+A4)/2,and the preoperative vertebral compression rate =(A-A1 )/A, the postoperative vertebral compression rate =(A-A2)/A, the restoring rate = (the preoperative vertebral compression rate-the postoperative vertebral compression rate)/the preoperative vertebral compression rate. ④ The wounds of the patients were observed after operation. The levels of blood routine, serum calcium and serum phosphorus were detected before, one day and one week after operation. MAIN OUTCOME MEASURES: ① Preoperative and postoperative VAS scoring. ② The vertebral compression rate and restoring rate. ③ Wounds were observed after operation. The blood routine, the serum calcium and serum phosphorus were detected before, one day and one week after operation.RESULTS: Totally 34 patients were involved in the result analysis. ①The preoperative visual analogue scale (VAS) score of experimental group were (91.5±21.7) points, and the postoperative ones were (44.5±27.2) points. The difference of VAS score reduced gradually along with the postoperative time. There was no difference of VAS score between experimental group and the control group 4 weeks after operation. ② The biocompatibility of CHC in the vertebral body was fine. The vertebral compression rate of experimental group was recovered from (43.1±21.4)％ preoperatively to (27.3± 18.5)％ postoperatively. The rate of restored heights was (27.3±18.5)％. ③ All patients obtained Ⅰ stage wound healing, and none of them had infection, inflammatory secretion and nervous symptom. There were no differences in blood routine test, serum calcium, serum phosphorus between patients in two groups. One case filled by PMMA and two cases filled by CHC presented leakage, and none had nervous symptom.CONCLUSION: As the filling materials for vertebropalsty, CHC can restore the vertebral heights and relieve pain safely and effectively, however, its efficacy to relieve pain is not significant as PMMA in the short term.
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[Objective]To investigate surgical therapeutic methods of recurrent lumbar disc herniation(RLDH).[Method]From December 1996 to December 2003,a retrospective analysis on surgical treatment of 74 cases of RLDH was made and those cases acquired 1～5 years follow-up.There were 41 males,33 females aging from 21~53 years(mean,37.2 years),case history was 6~192 months from primary surgery to disc reprolapse(mean,37 months).Among primary surgery,9 cases were total laminectomy,23 cases were hemilaminectomy,31 cases were windowing,11 cases were microdiscectomy with diskoscope.Re-surgery:5 cases treated with lumbar disc excision,45 cases treated with posterior lumbar interbody fusion(PLIF)technich,23 cases treated with transforminal lumbar interbody fusion(TLIF)technich.[Result]No death case occurred during peri-operation.Various complications were found in 18 cases which recovered by symptomatic treatment.Cases with lumbar disc excision left bed in 3 weeks with the help of lumbar back brace and cases with fusion surgery left bed in 3～5 d after surgery.Oswestry score improved from(52.32?9.17)pre-operatively to(20.33?5.72)in average 18 months follow-up.Totally 73.5% cases had satisfactory surgical results.[Conclusion]Cases with RLDH can adopt propotional surgical methods,thoroughly decompression and gain satisfactory therapeutic effect on bases of imageology,clinical manifestation and surgery history.
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<p><b>OBJECTIVE</b>To evaluate the efficacy of allograft fibula in anterior cervical fusion for cervical spondylosis patients treated by Smith-Robinson operation supplemented with anterior instrumentation.</p><p><b>METHODS</b>The clinical outcome of 38 patients with cervical spondylosis treated by Smith-Robinson operation using allograft fibula supplemented with anterior titanium plate were retrospectively studied. The patients were followed up on average was (9.5 +/- 3.4) months. The average preoperative and postoperative JOA scores were assessed and myelopathy severity was graded using the Nurick myelopathy grading system. Lateral views in neutral position, in flexion, and in extension of preoperative cervical roentgenograms were analyzed in comparison with last follow-up films to identify the changes in the height of intervertebral space and the quality of fusion.</p><p><b>RESULTS</b>Statistical analysis of all patients revealed mean JOA scores of 12.54 +/- 1.62 and 16.07 +/- 1.13 before surgery and at final examination (P < 0.05), respectively. And the mean Nurick grades were 2.46 +/- 0.43 and 0.72 +/- 0.37 before and after surgery (P < 0.05), respectively. Radiographic follow-up revealed that the height intervertebral space and the lordosis of the cervical spine had been restored and no allograft was found displaced or collapsed and also revealed that all grafts obtained union by 5 months after surgery.</p><p><b>CONCLUSIONS</b>Fibular allograft can replace autologous iliac crest graft in the treatment of cervical spondylosis patients. This method is safe and efficacious and can avoid bone graft-site morbidity.</p>
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Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vértebras Cervicais , Patologia , Fíbula , Cirurgia Geral , Osteofitose Vertebral , Cirurgia Geral , Transplante HomólogoRESUMO
Bi-polar,bi-pedicled separation delayed flaps were designed on the backs of New Zealand rabbits with the application of a medical silicon membrane as the separation material. Values of glucose and lactic acid, PtcO 2 were measured separately at proximal,middle and distal areas of the flaps after the distal pedice was cut at 0,1,4,7,14,21 days,respectively, after the formation of flaps. After flap delaying,PtcO 2 in separated flap was always lower than that of the mormal control,accompanied with glucose decrease and lactic acid increase, although there were significant differences in different areas of the flap. The survived area of the flap increased after 7 days. Furthermore,all the length of the flap survived after 21 days,although the level of glucose in the flap was still lower and lactic acid was still higher.The results suggested that by separation and delaying the flap may adapt gradually to hypoxia via lowered metabolism.For flap survival,the threshold value of glucose in flap is 0 01mmol/L , lactic acid is 0 47mmol/L,and PtcO 2 is 3mmHg .
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Objective To investigate the effect of surgical decompression on lumbar spinal stenosis in senile people. Method 175 senile patients with lumbar spinal stenosis were admitted from Jan. 1997 to Dec. 2003. Among them, the data of effect of surgical decompression in 106 cases, including 49 males and 57 females, age ranged from 70 to 82 years, all of them having a disease history of 4-10 years, and followed-up for 2-6 years after the operation. Their data were analyzed retrospectively. All the patients had been treated conservatively. 42 patients were complicated by one internal disease, and 55 complicated by at least 2 internal diseases. In all the patients continuous movement could not last longer than 15 min before operation. Lamina decompression was done in 95 patients, and a combined operation of lamina decompression, pedicle fixation and post-lateral bone grafting in 11 patients. Result All the patients survived the operation. Complications occurred in 38 cases, and the patients recovered after effective treatment. During follow-up, lumber complaint was improved in 37 cases, numbness in both legs was improved in 63 cases, and no satisfactory improvement was seen in 6 cases. In 66 cases the Oswestry score was lower than 20%, and in 34 cases it was lower than 10%. The result of surgical decompression was satisfactory in 94% of cases, and the average continuous movement was prolonged to over 30 min after operation. Conclusion Based on the effective control of complicated disease, the operative treatment of lamina decompression with fusion or no fusion played an important role in the recovery of neurological function in senile patients with lumbar stenosis.
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Objective To summarize clinical manifestations and diagnostic criteria of ischemic reperfusion (IR) injury to the spinal cord. Method The clinical manifestations and management of 15 cases of spinal cord IR injury after operation during 2000 to 2005 were retrospectively analyzed. Result All the patients with spinal cord IR injury presented progressive ascending motor and sensory functional impairment beginning from lower extremities 3h post operation, and they were all treated immediately with methylprednisolone and neurotrophy drugs to restore spinal cord function. However, mechanical compression with organic lesion should be ruled out to establish the diagnosis of spinal cord IR injury in the retrospective analysis. Different stages of spinal cord IR injury occurred in these 15 cases. Through symptomatic treatment, 8 patients recovered completely; the clinical symptoms were basically improved in 4 cases who could lead a normal life; in 3 patients clinical symptoms were improved but not satisfactory. Conclusion Though spinal cord IR injury seldom occurs in the clinic, its damage is disastrous. Proper management is critical to save patients from poor life quality.
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Objective A retrospective study of the results of surgical or non-operative treatment in patients with herniation of lumbar disc 10 years or longer before,in order to evaluate the efficacy of different therapeatic strategies for lumbar disc herniation. Method Definite diagnosis of lumbar disc herniation was made in all cases before treatment,and the follow-up period was 10 to 38 years. The patients were divided into three groups according to different treatment methods: non-operative group,simple nucleus resection group,and nucleus resection combined with space fusion group. The long term therapeutic effects and image change of the three groups were observed. The difference of height of intervertebral space at the herniation site was measured before treatment and at the latest follow-up. Adjacent spaces were also observed. The data were analyzed statistically by t -test and ? 2 -test. Results Among 98 cases in non-operative group,85 cases enjoyed almost a normal life and work;vertebral canal decompression was performed for the rest 13 cases because of intermittent claudication. The protruded space was narrowed for 3.17?1.65mm in height in average after non-operative treatment,and there was degeneration of adjacent spaces in 13 cases. Among the 84 cases in simple nucleus resection group,relative good outcome was seen in 71 patients,and the remaining 13 cases had to receive a second operation because of symptom relapse. The protruded space was decreased 5.50?1.51mm in height in average as measured at the latest follow-up comparing with that of before operation. The degeneration of the adjacent space was observed in 15 cases. In 71 patients who received nucleus resection combined with space fusion experienced a good relief of symptoms. The space,where disc herniation had occurred,fused very well and no re-narrowing occurred. Degeneration of the adjacent space was observed in 39 cases,but the patients were symptomless. Conclusions The effect of either non-operative therapy or operation for patients with lumbar disc herniation was good after a long-term follow-up if the indication was chosen properly. We suggest that non-operative therapy should be the first choice for the lumbar disc herniation. The relatively normal nucleus should be preserved as much as possible when nucleus resection was performed. Intervertebral fusion was a relative better treatment comparing with the other two treatments.
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Fourty-three cases with spinal tumors treated with vertebral resection were reviewed regarding the preoperative treatment, the operations, and the results, in order to evaluate the value of resection of the vertebral body in prolonging the survival time and in improving the life quality of the patients. All the patients showed neurological recovery after surgical decompression. The average improvement was 2 grades by Frankel system. A second operation was necessary in 3 cases with recurrent lesions. Pulmonary and urinary complications were found in 3 cases. Absorption of bone grafts, collapse of vertebrae and loosening of implants were found in 2 cases. Resection of the involved tissue or segments and re-establishment of stability have become the most important treatment modality for patients with spinal tumors. With the help of adjuvant therapy, the survival time and the life quality of patients have been greatly improved.
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OBJECTIVE:To evaluate the economic effects of different doses of methylprednisolone treatment regimes on traumatic reaction in patients with cervical spondylotic myelopathy after anterior decompressive operation.METHODS:56cervical spondylotic myelopathy cases who have been subjected to anterior decompressive operation were chosen to be the sub-jects.The56cases were divided into3groups and treated with different dosage of methylprednisolone,the initial dose for group A(18cases,low dose group)was80mg;the initial dose for group B(21cases,medium dose group)was600mg and that for group C(17cases,large dose group)was1000mg,the improvement of clinical symptom of each group was observed re-spectively and the cost-effectivenesses of the three groups were compared.RESULTS:The costs of the A,B,C groups were990.00,1339.10and1886.70yuan respectively;the effectiveness rates(E)of the A,B,C groups were5.56%,14.29%and35.29%respectively;The costs for each unit of obvious effectiveness(C/E)of the A,B,C groups were178.06,93.71and53.46yuan respectively;On the basis of group A,the needed costs of group B and C were39.99and30.16yuan respectively for each obvious effectiveness unit increase(?C/?E).CONCLUSION:Compared with group A and B,the effectiveness rates of group C had a bigger increase while the needed cost for each unit of obvious effectiveness was the lowest,therefore,the dose regimen of group C is more rational.
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Relation between change of capillary pressure, survival length in bi pedicled separation delay flap was observed. Bi polar, bi pedicled separation delay flaps were designed on the backs of New Zealand rabbits. Medical silicon membrane was used as separative material. Values of capillary pressure were measured at proximal, middle and distal points. Survival length increased with delayed time, capillary pressure at middle was lower in the bi pedicled separation delay flap. It is concluded that capillary pressure is increased greatly by separation delay, and there is a linear relation between capillary pressure and survival length of flaps.
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Objective To investigate the diagnosis and treatment of delayed infection after pedicle screw internal fixation via posterior approach. Methods The management of 17 cases of delayed infection after posterior pedicle screw internal fixation was retrospectively analyzed. Imaging examination was done before operation in all the patients. In petients whose operation was done within 9 months and non-fusion of bone graft was proved, debridement and suction-irrigation were given. For the patients in whom bone graft had fused, the implant was removed, followed by debridement, irrigation, and wound closure. Specimens were taken during operation for bacteriological study. Intravenous antibiotic was given after operation in all the patients. When 3 successive bacterial culture of wound drainage were proved to be negative and total drainage fluid was less than 50ml in 24h, drainage tube was removed. Results Wounds healed in all the patients. In 8 of 12 cases wound healed after debridement and irrigation-suction. In 9 patients fusion of the bone graft was confirmed, and internal fixators were removed, followed by debridement, irrigation-suction and primary closure of the incisions. In 4 cases infection recurred 3-18 months after first stage debridement and irrigation-suction, but X-ray confirmed that there was fusion of the bone graft. In 11 of 17 cases bacterial cultures were positive. Conclusions Delayed infection is a severe complication after internal fixation of the spine. Debridement and irrigation-suction are effective in controlling infection, and at the same time, it allows fusion of the bone graft. Removal of the internal fixators is not indispensable.
