Treating pyogenic lumbar spondylodiscitis with lateral debridement and fusion (XLIF): A retrospective study on the clinical outcomes and radiological characteristics

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Traditional posterior open surgery involves significant surgical trauma, non-direct vision debridement, and the possibility of bringing the front infection to the back. In contrast, extreme lateral interbody fusion (XLIF) offers several advantages over traditional open surgery, including minimal trauma, less bleeding, a shorter recovery period, and direct vision debridement. The objective of this study is to assess the safety and feasibility of XLIF for treating PLS, mainly focusing on evaluating the indirect decompression. Methods This retrospective study included 30 patients who were diagnosed with PLS and underwent XLIF and posterior fixation in the First Affiliated Hospital of the Army Medical University from 2015 to 2021. The clinical outcomes were assessed using the Oswestry Disability Index (ODI), visual analogue scale scores (VAS), American Spinal Injury Association (ASIA) grade and modified Macnab criteria. Radiological characteristics including lumbar sagittal balance and indirect decompression parameters were evaluated using lumbar X-ray and CT scan. The complications were recorded. Results At the final follow-up, the VAS and ODI scores were significantly reduced, and the ASIA grades were improved in all cases. The global and segmental lumbar lordosis were restored. Moreover, the postoperative indirect decompression parameters, including the disc height, foraminal height and area, central canal area and diameter, were all increased significantly. Inflammatory markers decreased to normal level at 3 months postoperatively. Bony fusion was achieved for all cases and the excellent/good rate was 100% at the final follow-up. There was no recurrency and severe complication recorded. Conclusions XLIF is a suitable alternative to traditional open surgeries in treating PLS. It is a minimally invasive surgery that involves radical debridement while achieving sufficient decompression. Trail registration: This clinical study was retrospectively registered in the First Affiliated Hospital of the Army Medical University on May 14, 2019 with the registration number KY201959. Minimally invasive Extreme lateral lumbar interbody fusion (XLIF) Pyogenic lumbar spondylodiscitis (PLS) Percutaneous fixation Indirect decompression Figures Figure 1 Figure 2 Background Pyogenic spinal infection, known as intervertebral space infection or pyogenic spondylodiscitis, is a serious disease with an incidence of 1:100,000 to 1:250,000 per year [ 1 , 2 , 3 ]. It is a bacterial infection invading the disc and adjacent vertebrae or elements [ 3 , 4 , 5 ]. Pyogenic spondylodiscitis represents approximately 2%-7% of systemic osteomyelitis [ 3 , 6 ], and lumbar spine is the most common lesion site, accounting for about 50% [ 6 , 7 , 8 ]. The manifestations of pyogenic lumbar spondylodiscitis (PLS) are non-specific and primarily present as severe back pain and compulsive posture, accompanied with systematic symptoms (e.g., night sweats, chills and fever). Some patients develop symptoms of neurologic deficits, lumbar instability and spinal deformity, which need earlier to be managed for preventing deterioration [ 9 , 10 ]. Given radical debridement and direct decompression, open surgery has long been prioritized to treat PLS with satisfactory outcomes. However, the disadvantages of open surgeries with massive trauma are apparent, including large incision, long operation time, massive blood loss, relative complications and prolonged postoperative recovery [ 11 , 12 , 13 ]. The XLIF technique allows a minimally invasive approach of lumbar interbody fusion, displaying merits of slight trauma and less complications [ 14 , 15 , 16 ]. Although XLIF has been reported to be effective in treating lumbar infection, few literatures can be accessible with regard to radiological parameters of indirect decompression [ 17 , 18 , 19 , 20 ]. In this study, 30 cases with pyogenic lumbar infection were treated using XLIF. The clinical and radiological data were collected and analyzed. Methods Inclusion and Exclusion Criteria A total of 30 consecutive patients with PLS and underwent XLIF and posterior fixation from 2015 to 2021 were reviewed for this research. Patients were included if there were symptoms of nerve compression, spinal deformity, lumbar instability, paraspinal giant abscess formation, failure of standard conservative treatment, progressive neurologic symptoms or lesions confined to the anterior and middle columns of spine. Those with one of the following conditions were excluded: a) rigid canal stenosis requiring additional posterior decompression; b) follow-up < 12 months; c) without systematic antibiotic treatment management; d) no chance of placing percutaneous pedicle screws due to severe destruction of vertebral bodies. Diagnostic Criteria PLS was diagnosed following the criteria proposed by Beronius [ 1 ]. Preoperative laboratory tests covered blood routine, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and blood sample culture. Radiological examinations consisted of biopsy under computed tomography (CT) navigation, postero-anterior and flexion-extension X-ray, CT with three-dimensional reconstruction and magnetic resonance imaging (MRI). Patient Management Patients with definite diagnosis or highly skepticism underwent intravenous antibiotic treatment. The combination of vancomycin and levofloxacin was employed for empirical antibiotic treatment. For cases with microbiological diagnosis, antibiotics were chosen according to the results of drug sensitivity tests. Inflammatory markers were tested every 3–5 days preoperatively. Generally, surgery was conducted when body temperature and white blood cell (WBC) were normal, as well as ESR level reduced to less than 40 mm/h. The antibiotic administration continued for 8–12 weeks postoperatively. A custom-made brace was equipped for at least three months until clinical symptoms were relieved and bone fusion was confirmed by CT scans. Surgical procedure The XLIF sugery was performed using a previously reported method [ 21 ]. Usually, incision was made on the side with more severe bone destruction or abscess. Otherwise, the right lateral decubitus position and left approach were generally taken. Intraoperatively, paraspinal abscess, if existed, could be found after spreading the psoas muscle and exposure of paraspinal tissues. After the retractor was mounted, the annulus was cut open, the pus and necrotic tissues were collected for bacterial culture, drug sensitivity test and pathological examination. All the pus and necrotic tissues must be fully removed. A bone file was used to deal with the inferior and superior margin of the proximal and distal vertebrae until healthy bone was revealed and bleeding. The intervertebral space was rinsed with 3% hydrogen peroxide, 2% povidone iodine solution and normal saline in sequence. Subsequently, a PEEK cage (Depuy Synthes Co., USA) was selected after model test for implantation. To improve interbody fusion, 20 mL of bone marrow was extracted and repeatedly infiltrated through allogeneic cancellous bone chips using the Bone Growth Promotor (FWS Medical Device Co., Ltd., Chongqing, China) for enrichment for 4 cycles according to the manufacturer’s instructions. In cases of severe vertebral disruption, beyond the cage’s available hight, a cubic autologous iliac bone was harvested as the fusion material. Before the incision was closed, the surgical area was irrigated copiously again and covered by a gelatin sponge soaked with 1 g of vancomycin. After patients were shifted to prone position, posterior percutaneous instruments were performed. Data Collection Clinical data including WBC, ESR, CRP, VAS, ODI and ASIA classification grade were collected. Inflammatory markers were compared between preoperatively and 3 months postoperatively. The nerve function was assessed by ASIA classification. VAS and ODI were assessed preoperatively, 1.5, 6, 12 months postoperatively and the final follow-up. The modified Macnab function evaluation criteria was evaluated at the final follow-up. X-ray and 3D-CT were performed to assess the spinal restoration and bone fusion. Based on the PACS system (INFINITT Inc.), global and segmental lumbar lordosis, sacral slope and disc height were measured on the lateral X-ray results (Fig. 1 A, 1 B, 1 C). The foraminal area, foraminal height, central canal area and central canal diameter were calculated from CT scans (Fig. 1 D, 1 E). The fusion rate was assessed according to the criteria of Siepe [ 22 ]. Statistical analysis Data were analyzed using SPSS 23.0 software (IBM SPSS Inc. Armonk, NY, USA). Paired t-test was conducted to assess the difference between the preoperative and postoperative disc height, foraminal area, foraminal height, central canal diameter and area. Repeated-measures ANOVA was carried out for evaluating global lumbar lordosis, segmental lordosis, sacral slope, VAS and ODI scores. P values < 0.05 were considered with statistical significance. Results Demographics Data Patient demographics were summarized in Table 1 . A total of 30 cases (18 males and 12 females) were included with a mean follow-up of 27.6 months (18–56 months). 33 levels were involved. 27 patients received operations at one level and 3 patients at double levels. The involved levels were: T12-L1 in 3 cases (9%), L1-2 in 3 cases (9%), L2-3 in 7 cases (21%), L3-4 in 12 cases (37%) and L4-5 in 8 cases (24%). Totally, 29 PEEK cages and 4 autogenous iliac bone grafts were implanted. The mean operative time were 273.8 ± 54.1 min per segment and the mean intraoperative blood loss were 250.0 ± 58.6 mL. The mean time to postoperative ambulation required 4.3 ± 2.4 days. Table 1 Summary of clinical data of 30 cases with pyogenic lumbar spondylodiscitis Case No Age (years） Sex Level Follow-up（m） Main complaints Operative time (minutes) Blood loss (ml) Graft Pathologic diagnosis Time to post-operative ambulation（d） Blood or tissue culture Postop complications 1 46, M L1-2 26 Pain in the low back and lower limps 373 300 Peek Chronic pyogenic inflammation 6 Negative abdominal distension，urinary bruise 2 61, M L2-3 28 Pain in the low back and lower limps 181 200 Peek Chronic pyogenic inflammation 3 Staphylococcus aureus Numbness in the thigh L3-4 181 200 Peek 3 49, M L3-4 56 Pain in the low back and right leg 278 250 Peek Chronic pyogenic inflammation 2 Micrococcus None 4 61, M L3-4 29 Low back pain 253 250 Peek Chronic pyogenic inflammation with microabscess 2 Staphylococcus aureus None 5 61, M T12-L1 41 Low back pain 233 200 Peek Chronic pyogenic inflammation 3 Negative Pain in the thigh L4-5 233 200 Bone 6 27, F L4-5 47 Pain in the low back and lower limps 265 250 Peek Chronic pyogenic inflammation with microabscess 2 Negative None 7 61, F L3-4 36 Pain in the low back and lower limps 195 200 Peek Chronic pyogenic inflammation 3 Negative None L4-5 195 200 Peek None 8 56, M L3-4 24 Pain in the low back and lower limps 333 200 Bone Chronic pyogenic inflammation with microabscess 2 Staphylococcus aureus None 9 65, F L2-3 25 Low back pain 283 200 Bone Chronic pyogenic inflammation 2 Escherichia coli None 10 18, F L3-4 24 Pain in the low back and lower limps 318 300 Peek Chronic pyogenic inflammation 4 Negative None 11 67, M L3-4 24 Pain in the low back and lower limps 328 300 Peek Chronic pyogenic inflammation 10 Stenotrophomonas maltophilia+Acinetobacter baumannii None 12 58, M L4-5 24 Pain in the low back and lower limps 250 200 Peek Chronic pyogenic inflammation 12 Negative None 13 63, F L4-5 26 Pain in the low back and lower limps 275 300 Peek Chronic pyogenic inflammation 5 Intermedius streptococci None 14 51, F L4-5 32 Pain in the low back and lower limps 292 200 Peek Chronic pyogenic inflammation 4 Negative None 15 64, M L2-3 25 Pain in the low back and left leg 294 300 Peek Chronic pyogenic inflammation 6 Proteus vulgaris+Candida albicans Cage subsidence 16 60, M L1-2 24 Low back pain 275 200 Peek Chronic pyogenic inflammation 3 Negative None 17 65, M L2-3 30 Low back pain 240 200 Peek Chronic pyogenic inflammation 4 Negative None 18 67, F L3-4 22 Pain in the low back and left leg 280 200 Peek Chronic pyogenic inflammation 7 Negative None 19 40, M T12-L1 30 Pain in the low back and left leg 295 300 Peek Chronic pyogenic inflammation with focal necrosis 5 Negative abdominal distension 20 57, M L2-3 24 Low back pain 300 200 Peek Chronic pyogenic inflammation 2 Negative None 21 60, F L3-4 24 Pain in the low back and right leg 230 300 Peek Chronic pyogenic inflammation 3 Staphylococcus hominis subspecies None 22 41, F L3-4 28 Low back pain 388 300 Peek Acute pyogenic inflammation with focal necrosis 4 Negative None 23 46, F L4-5 18 Low back pain 280 200 Peek Chronic pyogenic inflammation 3 Staphylococcus hominis subspecies None 24 48, M L1-2 24 Pain in the low back and lower limps 340 400 Bone Chronic pyogenic inflammation 7 Negative Cage subsidence 25 63, F L4-5 28 Pain in the low back and lower limps 190 300 Peek Chronic pyogenic inflammation 7 Negative None 26 45, M L3-4 24 Pain in the low back and lower limps 315 300 Peek Chronic pyogenic inflammation with bone necrotic 5 Staphylococcus aureus None 27 53, M L3-4 18 Pain in the low back and lower limps 256 150 Peek Chronic pyogenic inflammation with bone necrotic 3 Negative None 28 68, F L2-3 22 Low back pain 355 300 Peek Acute pyogenic inflammation with bone necrotic 3 Negative None 29 38, M T12-L1 20 Low back pain 305 300 Peek Chronic pyogenic inflammation 5 Negative abdominal distension 30 25, M L2-3 26 Pain in the low back and right leg 225 350 Peek Chronic pyogenic inflammation 3 Negative None F: female, M: male Etiological data and antibiotic management The blood or tissue culture were positive in 11 cases (36.7%). Of them, 8 had gram-positive bacteria infection including Staphylococcus aureus (4/11), Staphylococcus hominis subspecies (2/11), Micrococcus (1/11) and Streptococcus intermedius (1/11). 2 cases were diagnosed with gram-negative bacteria infection, one with Stenotrophomonas maltophilia plus Acinetobacter baumannii (1/11) and the other one with Escherichia coli (1/11). There was 1 case with mixed infection of gram-negative bacteria and fungi (Proteus vulgaris plus Candida albicans) (1/11). Postoperative histopathologic results suggested acute or chronic inflammation (Table 1 ). Preoperatively, all patients received antibiotic administration according to the drug sensitivity tests or empirical treatment. Antibiotic treatment was given for 21 weeks (19–24 weeks), via transvenous way for 12.1 weeks (11–16 weeks) and transoral way for 8.9 weeks (8–12 weeks). In this study, intravenous antibiotic therapy lasted 3.8 weeks (2–10 weeks) preoperatively and 8.3 weeks (8–10 weeks) postoperatively (Table 2 ). At 3 months postoperatively, WBC, ESR and CRP levels were decreased significantly ( P < 0.05) and returned to normal (Table 3 ). Table 2 Antibiotic therapy management (mean ± standard deviation) Case No Intravenous antibiotic treatment（Weeks） Postop oral antibiotic treatment（Weeks） Total antibiotic treatment (Weeks） Preop Postop Total 1 2 10 12 8 20 2 3 8 11 8 19 3 3 8 11 10 21 4 3 8 11 12 23 5 4 8 12 8 20 6 3 9 12 10 22 7 4 8 12 8 20 8 4 8 12 10 22 9 4 8 12 8 20 10 4 8 12 8 20 11 4 9 13 10 23 12 3 8 11 10 21 13 3 10 13 8 21 14 3 8 11 8 19 15 3 9 12 10 22 16 4 7 11 8 19 17 5 8 13 8 21 18 4 8 12 8 20 19 4 8 12 9 21 20 4 8 12 10 22 21 10 6 16 8 24 22 6 8 14 8 22 23 2 10 12 12 24 24 2 8 10 10 20 25 6 8 14 8 22 26 2 10 12 10 22 27 3 8 11 8 19 28 4 9 13 8 21 29 4 8 12 8 20 30 4 9 13 8 21 3.8±1.54 8.3±0.9 12.1±1.2 8.9±1.2 21.0±1.4 Table 3 Pre- and post-operative inflammatory makers (mean ± standard deviation) Item Pre-op Post-op 3-Mon P -value WBC ×10^9/L 8.0 ± 3.7 5.5 ± 0.8 P = 0.001 ESR (mm/h) 65.4 ± 24.9 14.2 ± 3.8 P = 0.000 CRP (mg/L) 48.8 ± 23.8 3.2 ± 1.3 P = 0.000 WBC: white blood cells, ESR: erythrocyte sedimentation rate, CRP: C-reactive protein At 3 months postoperatively, WBC, ESR and CRP decreased significantly ( P < 0.05) and returned to normal. Clinical outcomes At the final follow-up, the clinical symptoms of all cases were significantly relieved. VAS and ODI were significantly decreased from 6.8 ± 1.0 and 78.6%±8.9% to 0.6 ± 0.5 and 10.3%±3.0%, respectively ( P < 0.05). All patients were suffering from severe low back pain preoperatively, of which 20 cases were accompanied by pain or numbness in unilateral or bilateral lower limbs. According to the ASIA classification, 20 patients were identified as grade D and 10 as grade E preoperatively. All of the patients were improved to grade E at the final follow-up. Based on the modified Macnab evaluation criteria, the excellent/good rate was 100% with 15 excellent and 15 good (Table 4 ) . Table 4 Summary of clinical outcomes (means ± standard deviation) Assessment VAS ODI (%) ASIA grade(n = 30) Modified Macnab criteria evaluation(n = 30) A B C D E Excellent Good Average Poor Preop 6.8 ± 1.0 * 78.6 ± 8.9 * 0 0 0 20 10 - - - - 1.5-Mo Follow-Up 2.5 ± 0.8 # 22.5 ± 4.6 # - - - - - - - - - 6-Mo Follow-Up 1.5 ± 0.6 # 18.9 ± 3.5 # - - - - - - - - - 12-Mo Follow-Up 1.0 ± 0.6 # 11.6 ± 3.7 # - - - - - - - - - Final Follow-Up 0.6 ± 0.5 # 10.7 ± 3.0 # 0 0 0 0 30 15 15 0 0 ODI: Oswestry Disability Index, VAS: visual analogue scale, ASIA: American Spinal Injury Association # The postoperative pain scores decreased significantly, as compared to preoperative scores ( P < 0.05). The ASIA grades were improved with 100% excellent/good rate. Radiological characteristics The global and segmental lumbar lordosis increased 6.4° (15.2%) and 2.6 ° (35.6%), respectively ( P 0.05; Table 5 ). The radiological images at 12 months postoperatively suggested that all the indirect decompression parameters increased significantly ( P < 0.05). The disc heights of anterior and posterior increased 7.2 mm (101.4%) and 3.5 mm (68.6%); the foraminal areas of left and right enlarged 12.3 mm 2 (18.1%) and 15.1 mm 2 (22.7%); the foraminal heights of left and right increased 3.6 mm (28.6%) and 3.3 mm (26.0%); the central canal area and diameter improved 24.3 mm 2 (24.8%) and 3.0 mm (25.2%), respectively (Table 6 ). Bony fusion was achieved in all cases using the criteria of Siepe [ 22 ]. Table 5 Summary of sacral slope, global and segmental lumbar lordosis (mean ± standard deviation) Item Global lumbar lordosis(degree) Segmental lumbar lordosis(degree) Sacral slope(degree) Preop 42.0 ± 6.2 7.3 ± 8.0 34.6 ± 4.7 1.5-Mo Follow-Up 49.3 ± 8.2 # 10.8 ± 7.1 # 34.7 ± 4.6 * Final Follow-Up 48.4 ± 7.6 # 9.9 ± 6.6 # 34.5 ± 4.5 * # P 0.05, pre-op vs. post-op. Table 6 Summary of indirect decompression parameters (mean ± standard deviation) Item Preop 1-Year Follow-Up P -value Disc height(mm) Anterior 7.1 ± 2.5 14.3 ± 2.2 # 0.000 Posterior 5.1 ± 1.6 8.6 ± 1.9 # 0.000 Foraminal area (mm 2 ) Left 67.9 ± 11.9 80.2 ± 11.2 # 0.000 Right 66.6 ± 10.9 81.7 ± 11.1 # 0.000 Foraminal height (mm) Left 12.6 ± 2.5 16.2 ± 1.9 # 0.000 Right 12.7 ± 2.7 16.0 ± 2.2 # 0.000 Central canal area (mm 2 ) 97.8 ± 26.0 122.1 ± 27.0 # 0.000 Central canal diameter (mm) 11.9 ± 2.0 14.9 ± 1.9 # 0.000 # P < 0.05, pre-op vs. post-op. Complications The surgical wounds were healed for all patients. There was neither re-operation nor infection recurrence. Surgery related complications consisted of transient paresthesia in the thigh/groin (2/30 = 6.7%), abdominal distension (3/30 = 10%), graft subsidence (2/30 = 6.7%) and urinary bruise (1/30 = 3.3%). All patients were recovered after symptomatic and conservative treatments. Furthermore, there was no perioperative complication (e.g., dural sac tear, nerve root injury, large vessel rupture, deep vein thrombosis and pulmonary thromboembolism). At the final follow-up, no cage translation, screw and rod loosening/breakage was found. Discussion The treatment of PLS includes conservative treatment and surgical treatment. Conservative treatment mainly involves broad-spectrum antibiotics or sensitive antibiotics, and can cure most cases of PLS [ 5 ]. However, some cases require surgery, and the surgical indications are as follows. 1. Failure to respond to conservative therapy. 2. Significant or progressive neurologic deficits. 3. Large paraspinal abscess with local mass effect or septic embolization. 4. Significant osseous disease with involvement of more than two vertebral bodies, or greater than 50% loss in a single vertebral body. 5. Progressive deformity with or without incapacitating spinal posture. We show a typical pyogenic spondylodiscitis case treated with XLIF (Fig. 2 ). The main surgical purposes for lumbar spondylodiscitis include debridement of focal lesions, canal decompression, deformity correction and stability reconstruction [ 4 , 23 ]. To improve life quality and reduce the complications caused by long-term conservative treatment, some researchers advocate early surgical intervention [ 24 ]. Several surgical approaches, including anterior, posterior or combined anterior and posterior approaches, have been proposed for treating PLS [ 6 ]. However, anterior approach is associated with massive trauma and prolonged postoperative recovery [ 25 ]. Certain complications, such as intestinal obstruction, hemangioma, retrograde ejaculation and deep venous thrombosis, are nonnegligible, especially for patients in poor conditions [ 4 , 12 , 25 ]. In this context, posterior approach combined with internal fixation is a considerable alternative. This approach is simple, less traumatic, and allows debridement, interbody fusion and stability reconstruction in a single incision at the same time. However, complete debridement is relatively difficult under indirect visualization, which is likely to increase the risk of dural sac tear and nerve root injury. Besides, infection may spread from anterior and middle column to non-infected posterior column and surrounding normal tissues. Therefore, the posterior approach was usually used for patients with mild infection and relatively limited lesions [ 26 ]. As for combined surgery, the main advantages include complete debridement, decompression, bony fusion and stability reconstruction. Meanwhile, the debridement area is seperated from the internal fixation, thus infection spread can be avoided. However, certain drawbacks, including long operative time, increased blood loss, massive trauma and high rate of complications, are noteworthy. In the past decade, searching for an optimized surgical approach has become the research focus. XLIF, firstly proposed by Ozgur in 2006 [ 21 ], is one of the minimally invasive procedures for treatment of PLS. Primarily, it was used for treating lumbar degenerative disease, where advantages including little trauma, shorter operation time, less blood loss, faster postoperative recovery and fewer complications were verified [ 14 , 15 , 16 ]. Considering the ability of focus debridement under direct visualization, the application of XLIF has been expanded to treat PLS. Via a working channel passing through the psoas to the lateral side of target disc, this approach allows sufficient exposure of lesions located in the anterior and middle column, making complete debridement accessiable. This viewpoint has been proved by previous literature [ 17 , 18 , 19 , 20 ]. In the present study, complete debridement was achieved in all cases and there was no recurrency, further confiming the feasibility of XLIF in treating PLS. Moreover, a large cage with lordosis (0–8 degrees) was placed into the intervertebral space intraoperatively, which was aimed to improve the sagittal alignment of spine and ensure sufficient decompression. Eventually, the global and segmental lumbar lordosis was significantly ameliorated. With the help of posterior instrumentation and the implanted cage, the stability reconstruction of spine was excellent. Besides, the symptoms were relieved immediately after surgery. Early postoperative ambulation (4.3 ± 2.4 days) was permitted and life quality was significantly improved. Although satisfactory outcomes have been reported previously, few literature focused on the quantitative evaluation of indirect decompression. Clinical trials on treating lumbar degenerative disease with XLIF provide us with some insights. Oliveira et al. reported that the mean disc height, foraminal height, foraminal area and the central canal diameter increased by 41.9%, 13.5%, 24.7%, and 33.1% respectively in 21 cases [ 15 ]. Wang et al. found that the indirect decompression parameters were remarkably improved except for the central canal area [ 27 ]. However, PLS differs from the degenerative spinal diseases. The collapse and kyphosis are much severer due to the erosion and destruction of intervertebral space. Consequently, the fold of posterior longitudinal ligament and ligamentum flavum results in the spinal stenosis and the symptoms of nerve compression. So far, there is no report assessing the indirect decompression with regard to treating PLS with XLIF. In this study, all the indirect decompression parameters, including the disc height, foraminal height and area, central canal area and diameter, were improved postoperatively. At the final follow-up, VAS and ODI scores were notably reduced ( P < 0.05) and the ASIA classification grades were improved with 100% excellent/good rate. Collectively, these findings suggested that for treating PLS, satisfactory indirect decompression results can be obtained from XLIF. In spite of its superiority in safety, the application of XLIF is associated with certain complications. As reported by Rodgers, the overall incidence reached 6.2% in 600 cases, of which 2.5% were surgically related and 0.7% were postoperative transient nerve injury [ 16 ]. Knight declared that the incidence of major complications was 8.6% in 58 cases and path-related nerve irritation accounted for 3.4% [ 14 ]. In this study, paresthesia in the thigh or groin, hip flexion weakness, abdominal distension, urinary injury and cage subsidence were recorded, although the mobidity was low. Consitent with others, the most common complication was the transient paresthesia in the thigh /groin, which disappeared within 4–6 weeks postoperatively [ 14 ]. This could be attributed to intraoperative irritation of the lumbar plexus and psoas major. Besides, abdominal distension and constipation were primarily associated with nerve irritation and prolonged bed rest. Symptoms were alleviated within 1 week after symptomatic treatment. Cage subsidence primarily occured in patients with severe breakage of bilateral cortical bone and osteoporosis, and no related symptom was found. Conclusions In this study, we reported the effectiveness and safety of treating PLS with XLIF. The lateral approach allowed complete debridement under direct vision. The application of large cages, together with posterior fixation, significantly improved the lumbar lordosis and stability reconstruction. More importantly, the indirect decompression parameters were remarkably ameliorated and the symptoms were alleviated in all cases. There was no recurrency and severe complication. In summary, XLIF is a suitable approach for treaing PLS. In the end, the sample size in this study is small because of the low incidence of PLS. There are some limitations in this study, such as retrospective nature, no comparative group. In our future study, we will accumulate more cases and compare XLIF with traditional TLIF in the treatment of PLS. Declarations Ethics approval and consent to participate This study was approved by the First Affiliated Hospital of the Army Medical University Ethics Committee. The study were conducted in accordance with the local legislation and institutional requirements. We had necessary informed consent from all patients involved in the study. Consent for publication Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient. A copy of the consent form is available for review by the Editor of this journal. Availability of data and materials All data collected or analyzed during this study are included in this published article and the detailed data that support the findings are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research was supported by the National Natural Science Foundation of China (Grant number 82272460) . Authors’ Contribution s XG and QH designed this study. ZY collected the data. YG and LZ analyzed and interpreted the data. HL and ZY drafted the article. HL critically revised the article. WS finished the rest of the work, such as study supervision, fundings, materials. All authors read and approved the final manuscript. 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Extreme lateral interbody fusion with posterior instrumentation for spondylodiscitis. J Clin Neurosci. 2015;22(11):1758–1761. Ghobrial GM, Al-Saiegh F, Franco D, et al. Lateral lumbar retroperitoneal transpsoas approach in the setting of spondylodiscitis: A technical note. J Clin Neurosci. 2017;39:193–198. He L, Xie P, Shu T, et al. Clinical and radiographical results of minimally invasive lateral transpsoas approach for treatment of septic spondylodiscitis of thoracolumbar and lumbar spine. World Neurosurg. 2018;116:e48-56. Patel NB, Dodd ZH, Voorhies J, et al. Minimally invasive lateral transpsoas approach for spinal discitis and osteomyelitis. J Clin Neurosci. 2015;22(11):1753–1757. Ozgur BM, Aryan HE, Pimenta L, et al. Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J. 2006;6(4):435–443. Siepe CJ, Stosch-Wiechert K, Heider F, et al. Anterior stand-alone fusion revisited: a prospective clinical, X-ray and CT investigation. Eur Spine J. 2015;24: 838–851. Gouliouris T, Aliyu SH, Brown NM. Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemoth. 2010;65(Suppl 3):iii11-iii24. Tsai TT, Yang SC, Niu CC, et al. Early surgery with antibiotics treatment had better clinical outcomes than antibiotics treatment alone in patients with pyogenic spondylodiscitis: a retrospective cohort study. BMC Musculoskel Dis. 2017;18(1):1–7. Fantini GA, Pappou IP, Girardi FP, et al. Major Vascular Injury During Anterior Lumbar Spinal Surgery. Spine. 2007;32(24):2751–2758. Lu ML, Niu CC, Tsai TT, et al. Transforaminal lumbar interbody debridement and fusion for the treatment of infective spondylodiscitis in the lumbar spine. Eur Spine J. 2015;24(3):555–560. Wang TY, Nayar G, Brown C, et al. Bony Lateral Recess Stenosis and Other Radiographic Predictors of Failed Indirect Decompression via Extreme Lateral Interbody Fusion (XLIF): Multi-Institutional Analysis of 101 Consecutive Spinal Levels. World Neurosurg. 2017;106:819–826. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3867704","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":267306521,"identity":"c244ec99-57bc-40d7-8f28-70fab2ad19b3","order_by":0,"name":"Hongwei Lu","email":"","orcid":"","institution":"Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Hongwei","middleName":"","lastName":"Lu","suffix":""},{"id":267306522,"identity":"a5976426-4a38-4071-9485-9322db97fa43","order_by":1,"name":"Zhengwei Yang","email":"","orcid":"","institution":"Department of Orthopaedics, the First Affiliated Hospital of the Army Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhengwei","middleName":"","lastName":"Yang","suffix":""},{"id":267306523,"identity":"da3468cc-b8af-498b-8c2d-fc14a4ff9ac7","order_by":2,"name":"Yang Guo","email":"","orcid":"","institution":"Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Guo","suffix":""},{"id":267306524,"identity":"51c4af6c-10c8-488c-8764-4278af15751d","order_by":3,"name":"Lian Zeng","email":"","orcid":"","institution":"Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Lian","middleName":"","lastName":"Zeng","suffix":""},{"id":267306525,"identity":"0ec7bcf2-27c1-49b5-98ba-b44e4c4a144c","order_by":4,"name":"Wenzhe Sun","email":"","orcid":"","institution":"Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Wenzhe","middleName":"","lastName":"Sun","suffix":""},{"id":267306526,"identity":"4862a4f6-076a-4032-bd19-830850a3c1e4","order_by":5,"name":"Qingyi He","email":"","orcid":"","institution":"Department of Orthopaedics, the First Affiliated Hospital of the Army Medical University","correspondingAuthor":false,"prefix":"","firstName":"Qingyi","middleName":"","lastName":"He","suffix":""},{"id":267306527,"identity":"de80efd3-4cf6-4e75-b3b9-f3df7a17a3cd","order_by":6,"name":"Xiaodong Guo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYDACZiDmgTAZH0PFDIjWwmwMJCQIa2FAaGGTJkqLwXHmhw/eVNyxmx+RfKy6sK2ujoG9eZsEQ80dnFokm9mMDeeceZa88UZa2u2ZbYclGHiOlUkwHHuGUws/M4OZNG/b4WTDGTlmt3nbDkgwSOSYSTA2HMaphY2Z/RtcSzFvW50Eg/wb/Fr4mXnAttjJAw1n5m1jBtrCg1+LZDNPMdAvhxMMeJ4lS/OcOyzZxpNWbJFwDLcWg/PHNwJD7LC9fHvywc88ZXX8/OyHN974UINbCwwkbjgA8x2ISCCogYHBXr6BCFWjYBSMglEwMgEATA9MFjge0YUAAAAASUVORK5CYII=","orcid":"","institution":"Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology","correspondingAuthor":true,"prefix":"","firstName":"Xiaodong","middleName":"","lastName":"Guo","suffix":""}],"badges":[],"createdAt":"2024-01-15 21:00:00","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3867704/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3867704/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":49763887,"identity":"69d23619-c20c-4f16-88ab-827026863f7e","added_by":"auto","created_at":"2024-01-17 16:23:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":756922,"visible":true,"origin":"","legend":"\u003cp\u003eThe graph shows the preoperative parameters of a typical pyogenic spondylodiscitis case.\u003c/p\u003e\n\u003cp\u003e61-year-old man with pyogenic lumbar spondylodiscitis at the L3-4 level. (A) preoperative disc height; (B) preoperative foraminal area; (C) preoperative foraminal height; (D) preoperative central canal area; (E) preoperative central canal diameter.\u003c/p\u003e","description":"","filename":"figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-3867704/v1/4d081d1928b6d1f7d411ce65.png"},{"id":49763888,"identity":"2b44f19c-aba9-4cba-8625-54c58a90a49f","added_by":"auto","created_at":"2024-01-17 16:23:10","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":450041,"visible":true,"origin":"","legend":"\u003cp\u003eThe graph shows the typical pyogenic spondylodiscitis case treated with XLIF.\u003c/p\u003e\n\u003cp\u003eIllustration: (A) preoperative lateral X-ray film; (B) preoperative computed tomography (CT); (C) preoperative magnetic resonance imaging (MRI). (D) X-ray 1 year after operation; (E) CT 1 year after operation. After intravenous admistration of combined vancomycin and levofloxacin for 3 weeks, the symptoms progressively aggravated. Then, the XLIF surgery was performed. Postoperative tissue culture demonstrated positive staphylococcus aureus and the pathological result revealed chronic inflammation with microabscess.\u003c/p\u003e","description":"","filename":"figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-3867704/v1/ee518b6a087fdde7eb9cc2fe.png"},{"id":50210370,"identity":"92ebbb76-7aa7-4c56-8b15-7d47ebbac89b","added_by":"auto","created_at":"2024-01-26 10:58:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2041016,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3867704/v1/0aa9da52-00d5-4267-8fae-5c16f1496786.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Treating pyogenic lumbar spondylodiscitis with lateral debridement and fusion (XLIF): A retrospective study on the clinical outcomes and radiological characteristics","fulltext":[{"header":"Background","content":"\u003cp\u003ePyogenic spinal infection, known as intervertebral space infection or pyogenic spondylodiscitis, is a serious disease with an incidence of 1:100,000 to 1:250,000 per year [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It is a bacterial infection invading the disc and adjacent vertebrae or elements [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Pyogenic spondylodiscitis represents approximately 2%-7% of systemic osteomyelitis [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], and lumbar spine is the most common lesion site, accounting for about 50% [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The manifestations of pyogenic lumbar spondylodiscitis (PLS) are non-specific and primarily present as severe back pain and compulsive posture, accompanied with systematic symptoms (e.g., night sweats, chills and fever). Some patients develop symptoms of neurologic deficits, lumbar instability and spinal deformity, which need earlier to be managed for preventing deterioration [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Given radical debridement and direct decompression, open surgery has long been prioritized to treat PLS with satisfactory outcomes. However, the disadvantages of open surgeries with massive trauma are apparent, including large incision, long operation time, massive blood loss, relative complications and prolonged postoperative recovery [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The XLIF technique allows a minimally invasive approach of lumbar interbody fusion, displaying merits of slight trauma and less complications [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Although XLIF has been reported to be effective in treating lumbar infection, few literatures can be accessible with regard to radiological parameters of indirect decompression [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In this study, 30 cases with pyogenic lumbar infection were treated using XLIF. The clinical and radiological data were collected and analyzed.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eInclusion and Exclusion Criteria\u003c/h2\u003e \u003cp\u003eA total of 30 consecutive patients with PLS and underwent XLIF and posterior fixation from 2015 to 2021 were reviewed for this research. Patients were included if there were symptoms of nerve compression, spinal deformity, lumbar instability, paraspinal giant abscess formation, failure of standard conservative treatment, progressive neurologic symptoms or lesions confined to the anterior and middle columns of spine. Those with one of the following conditions were excluded: a) rigid canal stenosis requiring additional posterior decompression; b) follow-up \u0026lt;\u0026thinsp;12 months; c) without systematic antibiotic treatment management; d) no chance of placing percutaneous pedicle screws due to severe destruction of vertebral bodies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eDiagnostic Criteria\u003c/h2\u003e \u003cp\u003ePLS was diagnosed following the criteria proposed by Beronius [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Preoperative laboratory tests covered blood routine, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and blood sample culture. Radiological examinations consisted of biopsy under computed tomography (CT) navigation, postero-anterior and flexion-extension X-ray, CT with three-dimensional reconstruction and magnetic resonance imaging (MRI).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePatient Management\u003c/h2\u003e \u003cp\u003ePatients with definite diagnosis or highly skepticism underwent intravenous antibiotic treatment. The combination of vancomycin and levofloxacin was employed for empirical antibiotic treatment. For cases with microbiological diagnosis, antibiotics were chosen according to the results of drug sensitivity tests. Inflammatory markers were tested every 3\u0026ndash;5 days preoperatively. Generally, surgery was conducted when body temperature and white blood cell (WBC) were normal, as well as ESR level reduced to less than 40 mm/h. The antibiotic administration continued for 8\u0026ndash;12 weeks postoperatively. A custom-made brace was equipped for at least three months until clinical symptoms were relieved and bone fusion was confirmed by CT scans.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSurgical procedure\u003c/h2\u003e \u003cp\u003eThe XLIF sugery was performed using a previously reported method [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Usually, incision was made on the side with more severe bone destruction or abscess. Otherwise, the right lateral decubitus position and left approach were generally taken. Intraoperatively, paraspinal abscess, if existed, could be found after spreading the psoas muscle and exposure of paraspinal tissues. After the retractor was mounted, the annulus was cut open, the pus and necrotic tissues were collected for bacterial culture, drug sensitivity test and pathological examination. All the pus and necrotic tissues must be fully removed. A bone file was used to deal with the inferior and superior margin of the proximal and distal vertebrae until healthy bone was revealed and bleeding. The intervertebral space was rinsed with 3% hydrogen peroxide, 2% povidone iodine solution and normal saline in sequence. Subsequently, a PEEK cage (Depuy Synthes Co., USA) was selected after model test for implantation. To improve interbody fusion, 20 mL of bone marrow was extracted and repeatedly infiltrated through allogeneic cancellous bone chips using the Bone Growth Promotor (FWS Medical Device Co., Ltd., Chongqing, China) for enrichment for 4 cycles according to the manufacturer\u0026rsquo;s instructions. In cases of severe vertebral disruption, beyond the cage\u0026rsquo;s available hight, a cubic autologous iliac bone was harvested as the fusion material. Before the incision was closed, the surgical area was irrigated copiously again and covered by a gelatin sponge soaked with 1 g of vancomycin. After patients were shifted to prone position, posterior percutaneous instruments were performed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003eClinical data including WBC, ESR, CRP, VAS, ODI and ASIA classification grade were collected. Inflammatory markers were compared between preoperatively and 3 months postoperatively. The nerve function was assessed by ASIA classification. VAS and ODI were assessed preoperatively, 1.5, 6, 12 months postoperatively and the final follow-up. The modified Macnab function evaluation criteria was evaluated at the final follow-up.\u003c/p\u003e \u003cp\u003eX-ray and 3D-CT were performed to assess the spinal restoration and bone fusion. Based on the PACS system (INFINITT Inc.), global and segmental lumbar lordosis, sacral slope and disc height were measured on the lateral X-ray results (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003eA, \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003eB, \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003eC). The foraminal area, foraminal height, central canal area and central canal diameter were calculated from CT scans (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003eD, \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003eE). The fusion rate was assessed according to the criteria of Siepe [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using SPSS 23.0 software (IBM SPSS Inc. Armonk, NY, USA). Paired t-test was conducted to assess the difference between the preoperative and postoperative disc height, foraminal area, foraminal height, central canal diameter and area. Repeated-measures ANOVA was carried out for evaluating global lumbar lordosis, segmental lordosis, sacral slope, VAS and ODI scores. P values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered with statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eDemographics Data\u003c/h2\u003e \u003cp\u003ePatient demographics were summarized in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e1\u003c/span\u003e. A total of 30 cases (18 males and 12 females) were included with a mean follow-up of 27.6 months (18\u0026ndash;56 months). 33 levels were involved. 27 patients received operations at one level and 3 patients at double levels. The involved levels were: T12-L1 in 3 cases (9%), L1-2 in 3 cases (9%), L2-3 in 7 cases (21%), L3-4 in 12 cases (37%) and L4-5 in 8 cases (24%). Totally, 29 PEEK cages and 4 autogenous iliac bone grafts were implanted. The mean operative time were 273.8\u0026thinsp;\u0026plusmn;\u0026thinsp;54.1 min per segment and the mean intraoperative blood loss were 250.0\u0026thinsp;\u0026plusmn;\u0026thinsp;58.6 mL. The mean time to postoperative ambulation required 4.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4 days.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e Summary of clinical data of 30 cases with pyogenic lumbar spondylodiscitis\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"737\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eCase\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003cp\u003e(years）\u003c/p\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eLevel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eFollow-up（m）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003eMain complaints\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003eOperative\u003cbr\u003e\u0026nbsp;time\u003cbr\u003e\u0026nbsp;(minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eBlood\u003cbr\u003e\u0026nbsp;loss\u003cbr\u003e\u0026nbsp;(ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eGraft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003ePathologic diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eTime to\u003cbr\u003e\u0026nbsp;post-operative\u003cbr\u003e\u0026nbsp;ambulation（d）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eBlood or tissue\u003cbr\u003e\u0026nbsp;culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003ePostop complications\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e46, M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003ePain in the low back and lower limps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eChronic pyogenic inflammation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eabdominal distension，urinary bruise\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\" rowspan=\"2\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\" rowspan=\"2\"\u003e\n \u003cp\u003e61, M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL2-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\" rowspan=\"2\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\" rowspan=\"2\"\u003e\n \u003cp\u003ePain in the low back and lower limps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\" rowspan=\"2\"\u003e\n \u003cp\u003eChronic pyogenic inflammation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\" rowspan=\"2\"\u003e\n \u003cp\u003eStaphylococcus aureus\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\" rowspan=\"2\"\u003e\n \u003cp\u003eNumbness in the\u0026ensp;thigh\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.033755274261605%\"\u003e\n \u003cp\u003eL3-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.050632911392405%\"\u003e\n \u003cp\u003e181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.033755274261605%\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.033755274261605%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.848101265822784%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e49, M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL3-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003ePain in the low back and right leg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eChronic pyogenic inflammation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eMicrococcus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e61, M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL3-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003eLow back pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e253\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eChronic pyogenic inflammation with microabscess\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eStaphylococcus aureus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\" rowspan=\"2\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\" rowspan=\"2\"\u003e\n \u003cp\u003e61, M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eT12-L1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\" rowspan=\"2\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\" rowspan=\"2\"\u003e\n \u003cp\u003eLow back pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\" rowspan=\"2\"\u003e\n \u003cp\u003eChronic pyogenic inflammation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\" rowspan=\"2\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\" rowspan=\"2\"\u003e\n \u003cp\u003ePain in the\u0026ensp;thigh\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.033755274261605%\"\u003e\n \u003cp\u003eL4-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.050632911392405%\"\u003e\n \u003cp\u003e233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.033755274261605%\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.033755274261605%\"\u003e\n \u003cp\u003eBone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.848101265822784%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e27, F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL4-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003ePain in the low back and lower limps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eChronic pyogenic inflammation with microabscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\" rowspan=\"2\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\" rowspan=\"2\"\u003e\n \u003cp\u003e61, F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL3-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\" rowspan=\"2\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\" rowspan=\"2\"\u003e\n \u003cp\u003ePain in the low back and lower limps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\" rowspan=\"2\"\u003e\n \u003cp\u003eChronic pyogenic inflammation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\" rowspan=\"2\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.541254125412541%\"\u003e\n \u003cp\u003eL4-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.81188118811881%\"\u003e\n \u003cp\u003e195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.541254125412541%\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.541254125412541%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.782178217821784%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.782178217821784%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e56, M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL3-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003ePain in the low back and lower limps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eBone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eChronic pyogenic inflammation with microabscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eStaphylococcus aureus\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e65, F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL2-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003eLow back pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e283\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eBone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eChronic pyogenic inflammation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eEscherichia coli\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e18, F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL3-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003ePain in the low back and lower limps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e318\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eChronic pyogenic inflammation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e67, M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL3-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003ePain in the low back and lower limps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e328\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eChronic pyogenic inflammation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eStenotrophomonas maltophilia+Acinetobacter baumannii\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e58, M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL4-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003ePain in the low back and lower limps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eChronic pyogenic inflammation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e63, F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL4-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003ePain in the low back and lower limps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eChronic pyogenic inflammation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eIntermedius streptococci\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e51, F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL4-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003ePain in the low back and lower limps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eChronic pyogenic inflammation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e64, M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL2-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003ePain in the low back and left leg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eChronic pyogenic inflammation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eProteus vulgaris+Candida albicans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eCage subsidence\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e60, M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003eLow back pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eChronic pyogenic inflammation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e65, M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL2-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003eLow back pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eChronic pyogenic inflammation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e67, F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL3-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003ePain in the low back and left leg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eChronic pyogenic inflammation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e40, M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eT12-L1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003ePain in the low back and left leg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e295\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eChronic pyogenic inflammation with focal necrosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eabdominal distension\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e57, M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL2-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003eLow back pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eChronic pyogenic inflammation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e60, F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL3-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003ePain in the low back and right leg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eChronic pyogenic inflammation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eStaphylococcus hominis subspecies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e41, F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL3-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003eLow back pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e388\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eAcute pyogenic inflammation with focal necrosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e46, F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL4-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003eLow back pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eChronic pyogenic inflammation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eStaphylococcus hominis subspecies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e48, M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003ePain in the low back and lower limps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e340\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eBone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eChronic pyogenic inflammation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eCage subsidence\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e63, F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL4-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003ePain in the low back and lower limps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eChronic pyogenic inflammation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e45, M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL3-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003ePain in the low back and lower limps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eChronic pyogenic inflammation with bone necrotic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eStaphylococcus aureus\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e53, M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL3-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003ePain in the low back and lower limps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eChronic pyogenic inflammation with bone necrotic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e68, F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL2-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003eLow back pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e355\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eAcute pyogenic inflammation with bone necrotic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e38, M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eT12-L1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003eLow back pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eChronic pyogenic inflammation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eabdominal distension\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.368563685636857%\"\u003e\n \u003cp\u003e25, M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003eL2-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.241192411924118%\"\u003e\n \u003cp\u003ePain in the low back and right leg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.723577235772358%\"\u003e\n \u003cp\u003e225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003e350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.149051490514905%\"\u003e\n \u003cp\u003ePeek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eChronic pyogenic inflammation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.517615176151761%\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.94308943089431%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eF: female, M: male\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eEtiological data and antibiotic management\u003c/h2\u003e \u003cp\u003eThe blood or tissue culture were positive in 11 cases (36.7%). Of them, 8 had gram-positive bacteria infection including Staphylococcus aureus (4/11), Staphylococcus hominis subspecies (2/11), Micrococcus (1/11) and Streptococcus intermedius (1/11). 2 cases were diagnosed with gram-negative bacteria infection, one with Stenotrophomonas maltophilia plus Acinetobacter baumannii (1/11) and the other one with Escherichia coli (1/11). There was 1 case with mixed infection of gram-negative bacteria and fungi (Proteus vulgaris plus Candida albicans) (1/11). Postoperative histopathologic results suggested acute or chronic inflammation (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Preoperatively, all patients received antibiotic administration according to the drug sensitivity tests or empirical treatment. Antibiotic treatment was given for 21 weeks (19\u0026ndash;24 weeks), via transvenous way for 12.1 weeks (11\u0026ndash;16 weeks) and transoral way for 8.9 weeks (8\u0026ndash;12 weeks). In this study, intravenous antibiotic therapy lasted 3.8 weeks (2\u0026ndash;10 weeks) preoperatively and 8.3 weeks (8\u0026ndash;10 weeks) postoperatively (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e2\u003c/span\u003e). At 3 months postoperatively, WBC, ESR and CRP levels were decreased significantly (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and returned to normal (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e Antibiotic therapy management (mean \u0026plusmn; standard deviation)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"558\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.422939068100359%\" rowspan=\"2\"\u003e\n \u003cp\u003eCase No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.086021505376344%\" colspan=\"3\"\u003e\n \u003cp\u003eIntravenous antibiotic treatment（Weeks）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.448028673835125%\" rowspan=\"2\"\u003e\n \u003cp\u003ePostop oral antibiotic treatment（Weeks）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.043010752688172%\" rowspan=\"2\"\u003e\n \u003cp\u003eTotal \u0026nbsp;antibiotic treatment (Weeks）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.552845528455286%\"\u003e\n \u003cp\u003ePreop\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.89430894308943%\"\u003e\n \u003cp\u003ePostop\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.552845528455286%\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.422939068100359%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.620071684587813%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.448028673835125%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.043010752688172%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.422939068100359%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.620071684587813%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.448028673835125%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.043010752688172%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.422939068100359%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.620071684587813%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.448028673835125%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.043010752688172%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.422939068100359%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.620071684587813%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.448028673835125%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.043010752688172%\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.422939068100359%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.620071684587813%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.448028673835125%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.043010752688172%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.422939068100359%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.620071684587813%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.448028673835125%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.043010752688172%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.422939068100359%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.620071684587813%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.448028673835125%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.043010752688172%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.422939068100359%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.620071684587813%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.448028673835125%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.043010752688172%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.422939068100359%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.620071684587813%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.448028673835125%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.043010752688172%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.422939068100359%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.620071684587813%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.448028673835125%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.043010752688172%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.422939068100359%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.620071684587813%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.448028673835125%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.043010752688172%\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.422939068100359%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.620071684587813%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.448028673835125%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.043010752688172%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.422939068100359%\"\u003e\n 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width=\"13.620071684587813%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.448028673835125%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.043010752688172%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.422939068100359%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.620071684587813%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.448028673835125%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.043010752688172%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n 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width=\"15.232974910394265%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.620071684587813%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.448028673835125%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.043010752688172%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.422939068100359%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.620071684587813%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.448028673835125%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.043010752688172%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.422939068100359%\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.620071684587813%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.448028673835125%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.043010752688172%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.422939068100359%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.620071684587813%\"\u003e\n 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width=\"8.422939068100359%\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.620071684587813%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.448028673835125%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.043010752688172%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.422939068100359%\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.620071684587813%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.448028673835125%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.043010752688172%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.422939068100359%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.620071684587813%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.448028673835125%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.043010752688172%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.422939068100359%\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.620071684587813%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.448028673835125%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.043010752688172%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.422939068100359%\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.620071684587813%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.448028673835125%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.043010752688172%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.422939068100359%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e3.8\u0026plusmn;1.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.620071684587813%\"\u003e\n \u003cp\u003e8.3\u0026plusmn;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.232974910394265%\"\u003e\n \u003cp\u003e12.1\u0026plusmn;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.448028673835125%\"\u003e\n \u003cp\u003e8.9\u0026plusmn;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.043010752688172%\"\u003e\n \u003cp\u003e21.0\u0026plusmn;1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePre- and post-operative inflammatory makers (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-op\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost-op 3-Mon\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBC\u0026ensp;\u0026times;10^9/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e8.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eESR (mm/h)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e65.4\u0026thinsp;\u0026plusmn;\u0026thinsp;24.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e14.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP (mg/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e48.8\u0026thinsp;\u0026plusmn;\u0026thinsp;23.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eWBC: white blood cells, ESR: erythrocyte sedimentation rate, CRP: C-reactive protein\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAt 3 months postoperatively, WBC, ESR and CRP decreased significantly (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and returned to normal.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eClinical outcomes\u003c/h2\u003e \u003cp\u003eAt the final follow-up, the clinical symptoms of all cases were significantly relieved. VAS and ODI were significantly decreased from 6.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0 and 78.6%\u0026plusmn;8.9% to 0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5 and 10.3%\u0026plusmn;3.0%, respectively (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). All patients were suffering from severe low back pain preoperatively, of which 20 cases were accompanied by pain or numbness in unilateral or bilateral lower limbs. According to the ASIA classification, 20 patients were identified as grade D and 10 as grade E preoperatively. All of the patients were improved to grade E at the final follow-up. Based on the modified Macnab evaluation criteria, the excellent/good rate was 100% with 15 excellent and 15 good (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of clinical outcomes (means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAssessment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVAS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eODI (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c8\" namest=\"c4\"\u003e \u003cp\u003eASIA grade(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c12\" namest=\"c9\"\u003e \u003cp\u003eModified Macnab criteria evaluation(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreop\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e78.6\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.5-Mo\u0026ensp;Follow-Up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e22.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6-Mo\u0026ensp;Follow-Up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e18.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12-Mo\u0026ensp;Follow-Up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e11.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinal\u0026ensp;Follow-Up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"12\"\u003eODI: Oswestry Disability Index, VAS: visual analogue scale, ASIA: American\u0026ensp;Spinal\u0026ensp;Injury\u0026ensp;Association\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e#\u003c/sup\u003e The postoperative pain scores decreased significantly, as compared to preoperative scores (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The\u0026ensp;ASIA\u0026ensp;grades were improved with 100% excellent/good rate.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eRadiological characteristics\u003c/h2\u003e \u003cp\u003eThe global and segmental lumbar lordosis increased 6.4\u0026deg; (15.2%) and 2.6 \u0026deg; (35.6%), respectively (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No significant difference was observed in sacral slope change (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The radiological images at 12 months postoperatively suggested that all the indirect decompression parameters increased significantly (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The disc heights of anterior and posterior increased 7.2 mm (101.4%) and 3.5 mm (68.6%); the foraminal areas of left and right enlarged 12.3 mm\u003csup\u003e2\u003c/sup\u003e (18.1%) and 15.1 mm\u003csup\u003e2\u003c/sup\u003e (22.7%); the foraminal heights of left and right increased 3.6 mm (28.6%) and 3.3 mm (26.0%); the central canal area and diameter improved 24.3 mm\u003csup\u003e2\u003c/sup\u003e (24.8%) and 3.0 mm (25.2%), respectively (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e6\u003c/span\u003e). Bony fusion was achieved in all cases using the criteria of Siepe [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of sacral slope, global and segmental lumbar lordosis (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGlobal lumbar lordosis(degree)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSegmental lumbar lordosis(degree)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSacral slope(degree)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreop\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e42.0\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.3\u0026thinsp;\u0026plusmn;\u0026thinsp;8.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e34.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.5-Mo\u0026ensp;Follow-Up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e49.3\u0026thinsp;\u0026plusmn;\u0026thinsp;8.2\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e34.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinal\u0026ensp;Follow-Up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e48.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.6\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.6\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e34.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e#\u003c/sup\u003e \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, pre-op \u003cem\u003evs.\u003c/em\u003e post-op. \u003csup\u003e*\u003c/sup\u003e \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05, pre-op \u003cem\u003evs.\u003c/em\u003e post-op.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of indirect decompression parameters (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePreop\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1-Year Follow-Up\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDisc height(mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePosterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eForaminal area (mm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67.9\u0026thinsp;\u0026plusmn;\u0026thinsp;11.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80.2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.2\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81.7\u0026thinsp;\u0026plusmn;\u0026thinsp;11.1\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eForaminal height (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCentral canal area (mm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.8\u0026thinsp;\u0026plusmn;\u0026thinsp;26.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e122.1\u0026thinsp;\u0026plusmn;\u0026thinsp;27.0\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCentral canal diameter (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e#\u003c/sup\u003e \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, pre-op \u003cem\u003evs.\u003c/em\u003e post-op.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eComplications\u003c/h2\u003e \u003cp\u003eThe surgical wounds were healed for all patients. There was neither re-operation nor infection recurrence. Surgery related complications consisted of transient paresthesia in\u0026ensp;the\u0026ensp;thigh/groin (2/30\u0026thinsp;=\u0026thinsp;6.7%), abdominal distension (3/30\u0026thinsp;=\u0026thinsp;10%), graft subsidence (2/30\u0026thinsp;=\u0026thinsp;6.7%) and urinary bruise (1/30\u0026thinsp;=\u0026thinsp;3.3%). All patients were recovered after symptomatic and conservative treatments. Furthermore, there was no perioperative complication (e.g., dural sac tear, nerve root injury, large vessel rupture, deep vein thrombosis and pulmonary thromboembolism). At the final follow-up, no cage translation, screw and rod loosening/breakage was found.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe treatment of PLS includes conservative treatment and surgical treatment. Conservative treatment mainly involves broad-spectrum antibiotics or sensitive antibiotics, and can cure most cases of PLS [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, some cases require surgery, and the surgical indications are as follows. 1. Failure to respond to conservative therapy. 2. Significant or progressive neurologic deficits. 3. Large paraspinal abscess with local mass effect or septic embolization. 4. Significant osseous disease with involvement of more than two vertebral bodies, or greater than 50% loss in a single vertebral body. 5. Progressive deformity with or without incapacitating spinal posture. We show a typical pyogenic spondylodiscitis case treated with XLIF (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe main surgical purposes for lumbar spondylodiscitis include debridement of focal lesions, canal decompression, deformity correction and stability reconstruction [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. To improve life quality and reduce the complications caused by long-term conservative treatment, some researchers advocate early surgical intervention [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Several surgical approaches, including anterior, posterior or combined anterior and posterior approaches, have been proposed for treating PLS [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, anterior approach is associated with massive trauma and prolonged postoperative recovery [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Certain complications, such as intestinal obstruction, hemangioma, retrograde ejaculation and deep venous thrombosis, are nonnegligible, especially for patients in poor conditions [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In this context, posterior approach combined with internal fixation is a considerable alternative. This approach is simple, less traumatic, and allows debridement, interbody fusion and stability reconstruction in a single incision at the same time. However, complete debridement is relatively difficult under indirect visualization, which is likely to increase the risk of dural sac tear and nerve root injury. Besides, infection may spread from anterior and middle column to non-infected posterior column and surrounding normal tissues. Therefore, the posterior approach was usually used for patients with mild infection and relatively limited lesions [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. As for combined surgery, the main advantages include complete debridement, decompression, bony fusion and stability reconstruction. Meanwhile, the debridement area is seperated from the internal fixation, thus infection spread can be avoided. However, certain drawbacks, including long operative time, increased blood loss, massive trauma and high rate of complications, are noteworthy. In the past decade, searching for an optimized surgical approach has become the research focus.\u003c/p\u003e \u003cp\u003eXLIF, firstly proposed by Ozgur in 2006 [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], is one of the minimally invasive procedures for treatment of PLS. Primarily, it was used for treating lumbar degenerative disease, where advantages including little trauma, shorter operation time, less blood loss, faster postoperative recovery and fewer complications were verified [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Considering the ability of focus debridement under direct visualization, the application of XLIF has been expanded to treat PLS. Via a working channel passing through the psoas to the lateral side of target disc, this approach allows sufficient exposure of lesions located in the anterior and middle column, making complete debridement accessiable. This viewpoint has been proved by previous literature [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In the present study, complete debridement was achieved in all cases and there was no recurrency, further confiming the feasibility of XLIF in treating PLS. Moreover, a large cage with lordosis (0\u0026ndash;8 degrees) was placed into the intervertebral space intraoperatively, which was aimed to improve the sagittal alignment of spine and ensure sufficient decompression. Eventually, the global and segmental lumbar lordosis was significantly ameliorated. With the help of posterior instrumentation and the implanted cage, the stability reconstruction of spine was excellent. Besides, the symptoms were relieved immediately after surgery. Early postoperative ambulation (4.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4 days) was permitted and life quality was significantly improved.\u003c/p\u003e \u003cp\u003eAlthough satisfactory outcomes have been reported previously, few literature focused on the quantitative evaluation of indirect decompression. Clinical trials on treating lumbar degenerative disease with XLIF provide us with some insights. Oliveira \u003cem\u003eet al.\u003c/em\u003e reported that the mean disc height, foraminal height, foraminal area and the central canal diameter increased by 41.9%, 13.5%, 24.7%, and 33.1% respectively in 21 cases [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Wang \u003cem\u003eet al.\u003c/em\u003e found that the indirect decompression parameters were remarkably improved except for the central canal area [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. However, PLS differs from the degenerative spinal diseases. The collapse and kyphosis are much severer due to the erosion and destruction of intervertebral space. Consequently, the fold of posterior longitudinal ligament and ligamentum flavum results in the spinal stenosis and the symptoms of nerve compression. So far, there is no report assessing the indirect decompression with regard to treating PLS with XLIF. In this study, all the indirect decompression parameters, including the disc height, foraminal height and area, central canal area and diameter, were improved postoperatively. At the final follow-up, VAS and ODI scores were notably reduced (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and the ASIA classification \u0026ensp;grades were improved with 100% excellent/good rate. Collectively, these findings suggested that for treating PLS, satisfactory indirect decompression results can be obtained from XLIF.\u003c/p\u003e \u003cp\u003eIn spite of its superiority in safety, the application of XLIF is associated with certain complications. As reported by Rodgers, the overall incidence reached 6.2% in 600 cases, of which 2.5% were surgically related and 0.7% were postoperative transient nerve injury [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Knight declared that the incidence of major complications was 8.6% in 58 cases and path-related nerve irritation accounted for 3.4% [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In this study, paresthesia in the thigh or groin, hip flexion weakness, abdominal distension, urinary injury and cage subsidence were recorded, although the mobidity was low. Consitent with others, the most common complication was the transient paresthesia in the thigh /groin, which disappeared within 4\u0026ndash;6 weeks postoperatively [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This could be attributed to intraoperative irritation of the lumbar plexus and psoas major. Besides, abdominal distension and constipation were primarily associated with nerve irritation and prolonged bed rest. Symptoms were alleviated within 1 week after symptomatic treatment. Cage subsidence primarily occured in patients with severe breakage of bilateral cortical bone and osteoporosis, and no related symptom was found.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn this study, we reported the effectiveness and safety of treating PLS with XLIF. The lateral approach allowed complete debridement under direct vision. The application of large cages, together with posterior fixation, significantly improved the lumbar lordosis and stability reconstruction. More importantly, the indirect decompression parameters were remarkably ameliorated and the symptoms were alleviated in all cases. There was no recurrency and severe complication. In summary, XLIF is a suitable approach for treaing PLS.\u003c/p\u003e \u003cp\u003eIn the end, the sample size in this study is small because of the low incidence of PLS. There are some limitations in this study, such as retrospective nature, no comparative group. In our future study, we will accumulate more cases and compare XLIF with traditional TLIF in the treatment of PLS.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the First Affiliated Hospital of the Army Medical University Ethics Committee.\u0026nbsp;The study were conducted in accordance with the local legislation and institutional requirements. We had necessary informed consent from all patients involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent for publication of their clinical details and/or clinical images was obtained from the patient. A copy of the consent form is available for review by the Editor of this journal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data collected or analyzed during this study are included in this published article and the detailed data that support the findings are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was supported by the National Natural Science Foundation of China (Grant number 82272460)\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ Contribution\u003c/strong\u003e\u003cstrong\u003es\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXG and QH designed this study. ZY collected the data. YG and LZ analyzed and interpreted the data. HL and ZY drafted the article. HL critically revised the article. WS finished the rest of the work, such as study supervision, fundings, materials. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBeronius M, Bergman B, Andersson R. Vertebral osteomyelitis in Goteborg, Sweden: a retrospective study of patients during 1990-95. Infect Dis-Nor. 2001;33(7):527\u0026ndash;532.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHernandez PLM, Lopez MA, Vargas FZ, et al. Spontaneous infectious spondylodiscitis in an internal medicine department: epidemiological and clinical study in 41 cases. Rev Clin Esp 2008;208(7):347\u0026ndash;352.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuzzati R, Giacomazzi D, Danzi MC, et al. Diagnosis, management and outcome of clinically- suspected spinal infection. J Infection. 2009;58(4):259\u0026ndash;265.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZarghooni K, R\u0026ouml;llinghoff M, Sobottke R, et al. Treatment of spondylodiscitis. Int Orthop. 2012;36(2):405\u0026ndash;411.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen J, Xuan T, Lu Y, et al. Outcome of one-stage percutaneous endoscopic debridement and lavage combined with percutaneous pedicle screw fixation for lumbar pyogenic spondylodiscitis. J Orthop Surg. 2021;29(3):1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheung WY, Luk K. Pyogenic spondylitis. Int Orthop. 2012;36(2):397\u0026ndash;404.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBernard L, Dinh A, Ghout I, et al. Antibiotic treatment for 6 weeks versus 12 weeks in patients with pyogenic vertebral osteomyelitis: an open-label, non-inferiority, randomised, controlled trial. Lancet. 2015;385(9971):875\u0026ndash;882.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFriedman JA, Maher CO, Quast LM, et al. Spontaneous disc space infections in adults. Surg Neurol. 2002;57(2):81\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang H, Chen L, Moviglia G, et al. Advances and prospects of cell therapy for spinal cord injury patients. J Neurorestoratology. 2022;10(1):13\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuo X, Hu J, Feng S, et al. Clinical neurorestorative treatment guidelines for neurological dysfunctions of sequels from vertebral and spinal cord lesions (CANR 2023 version). J Neurorestoratology. 2023;11(3):100070.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerbari EF, Kanj SS, Kowalski TJ, et al. 2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults. Clin Infect Dis. 2015;61(6):859\u0026ndash;863.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePee YH, Park JD, Choi YG, et al. Anterior debridement and fusion followed by posterior pedicle screw fixation in pyogenic spondylodiscitis: autologous iliac bone strut versus cage. J Neurosurg Spine. 2008;8(5):405\u0026ndash;412.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVcelak, Chomiak J, Toth J, et al. Surgical treatment of lumbar spondylodiscitis: a comparison of two methods. Int Orthop. 2014;38(7):1425\u0026ndash;1434.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKnight RQ, Schwaegler P, Hanscom D, et al. Direct lateral lumbar interbody fusion for degenerative conditions: early complication profile. J Spinal Disord Tech. 2009;22(1):34\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOliveira L, Marchi L, Coutinho E, et al. A radiographic assessment of the ability of the extreme lateral interbody fusion procedure to indirectly decompress the neural elements. Spine. 2010;35(Supplement):331\u0026ndash;337.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRodgers WB, Gerber EJ, Patterson J. Intraoperative and early postoperative complications in extreme lateral interbody fusion: an analysis of 600 cases. Spine. 2011;36(1):26\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlizzard DJ, Hills CP, Isaacs RE, et al. Extreme lateral interbody fusion with posterior instrumentation for spondylodiscitis. J Clin Neurosci. 2015;22(11):1758\u0026ndash;1761.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhobrial GM, Al-Saiegh F, Franco D, et al. Lateral lumbar retroperitoneal transpsoas approach in the setting of spondylodiscitis: A technical note. J Clin Neurosci. 2017;39:193\u0026ndash;198.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHe L, Xie P, Shu T, et al. Clinical and radiographical results of minimally invasive lateral transpsoas approach for treatment of septic spondylodiscitis of thoracolumbar and lumbar spine. World Neurosurg. 2018;116:e48-56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatel NB, Dodd ZH, Voorhies J, et al. Minimally invasive lateral transpsoas approach for spinal discitis and osteomyelitis. J Clin Neurosci. 2015;22(11):1753\u0026ndash;1757.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOzgur BM, Aryan HE, Pimenta L, et al. Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J. 2006;6(4):435\u0026ndash;443.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSiepe CJ, Stosch-Wiechert K, Heider F, et al. Anterior stand-alone fusion revisited: a prospective clinical, X-ray and CT investigation. Eur Spine J. 2015;24: 838\u0026ndash;851.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGouliouris T, Aliyu SH, Brown NM. Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemoth. 2010;65(Suppl 3):iii11-iii24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsai TT, Yang SC, Niu CC, et al. Early surgery with antibiotics treatment had better clinical outcomes than antibiotics treatment alone in patients with pyogenic spondylodiscitis: a retrospective cohort study. BMC Musculoskel Dis. 2017;18(1):1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFantini GA, Pappou IP, Girardi FP, et al. Major Vascular Injury During Anterior Lumbar Spinal Surgery. Spine. 2007;32(24):2751\u0026ndash;2758.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLu ML, Niu CC, Tsai TT, et al. Transforaminal lumbar interbody debridement and fusion for the treatment of infective spondylodiscitis in the lumbar spine. Eur Spine J. 2015;24(3):555\u0026ndash;560.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang TY, Nayar G, Brown C, et al. Bony Lateral Recess Stenosis and Other Radiographic Predictors of Failed Indirect Decompression via Extreme Lateral Interbody Fusion (XLIF): Multi-Institutional Analysis of 101 Consecutive Spinal Levels. World Neurosurg. 2017;106:819\u0026ndash;826.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Minimally invasive, Extreme lateral lumbar interbody fusion (XLIF), Pyogenic lumbar spondylodiscitis (PLS), Percutaneous fixation, Indirect decompression","lastPublishedDoi":"10.21203/rs.3.rs-3867704/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3867704/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe surgical treatment of pyogenic lumbar spondylodiscitis (PLS) remains a controversial topic. Traditional posterior open surgery involves significant surgical trauma, non-direct vision debridement, and the possibility of bringing the front infection to the back. In contrast, extreme lateral interbody fusion (XLIF) offers several advantages over traditional open surgery, including minimal trauma, less bleeding, a shorter recovery period, and direct vision debridement. The objective of this study is to assess the safety and feasibility of XLIF for treating PLS, mainly focusing on evaluating the indirect decompression.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective study included 30 patients who were diagnosed with PLS and underwent XLIF and posterior fixation in the First Affiliated Hospital of the Army Medical University from 2015 to 2021. The clinical outcomes were assessed using the Oswestry Disability Index (ODI), visual analogue scale scores (VAS), American\u0026ensp;Spinal\u0026ensp;Injury\u0026ensp;Association\u0026ensp;(ASIA)\u0026ensp;grade and modified Macnab criteria. Radiological characteristics including lumbar sagittal balance and indirect decompression parameters were evaluated using lumbar X-ray and CT scan. The complications were recorded.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAt the final follow-up, the VAS and ODI scores were significantly reduced, and\u0026ensp;the\u0026ensp;ASIA\u0026ensp;grades\u0026ensp;were improved in all cases. The global and segmental lumbar lordosis were restored. Moreover, the postoperative indirect decompression parameters, including the disc height, foraminal height and area, central canal area and diameter, were all increased significantly. Inflammatory markers decreased to normal level at 3 months postoperatively. Bony fusion was achieved for all cases and the excellent/good rate was 100% at the final follow-up. There was no recurrency and severe complication recorded.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eXLIF is a suitable alternative to traditional open surgeries in treating PLS. It is a minimally invasive surgery that involves radical debridement while achieving sufficient decompression.\u003c/p\u003e\u003ch2\u003eTrail registration:\u003c/h2\u003e \u003cp\u003eThis clinical study was retrospectively registered in the First Affiliated Hospital of the Army Medical University on May 14, 2019 with the registration number KY201959.\u003c/p\u003e","manuscriptTitle":"Treating pyogenic lumbar spondylodiscitis with lateral debridement and fusion (XLIF): A retrospective study on the clinical outcomes and radiological characteristics","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-17 16:23:05","doi":"10.21203/rs.3.rs-3867704/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8c299cad-1252-49e5-a344-19d253307f2b","owner":[],"postedDate":"January 17th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-01-26T10:50:20+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-17 16:23:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3867704","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3867704","identity":"rs-3867704","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}