Feasibility of debridement combined with vacuum sealing drainage without bone grafting in the treatment of spinal infection

Spinal infection often causes vertebral damage, paravertebral abscess, nerve injury, and spinal instability. Traditional one-stage debridement plus bone graft and internal fixation carries high risks of graft-related complications in active infection. To evaluate the feasibility and safety of a bone graft-free protocol combining focal debridement, vacuum sealing drainage (VSD), and percutaneous trans-segmental pedicle screw fixation for primary spinal infection. The clinical data of 22 patients with primary thoracolumbar intervertebral infection treated with focal debridement, VSD placement, and graftless percutaneous trans-segmental internal fixation from Jan 2019 to Jun 2025 were retrospectively analyzed. Perioperative data, pre- and postoperative VAS, ODI, inflammatory biomarkers (WBC, CRP, ESR), and spinal stability imaging indexes (dynamic segmental angle, dynamic slip, local Cobb angle) were statistically compared. Follow-up complications such as recurrent infection, implant failure, and spinal deformity were documented. All surgeries succeeded with a minimum 1-year follow-up. There was no recurrent infection, neurological worsening, screw loosening or fracture, or unplanned revision. Postoperative inflammatory markers decreased by more than half, showing full infection control. The VAS, ODI, dynamic segmental angle, and dynamic slip decreased significantly postoperatively ( P < 0.05). The local Cobb angle remained stable without progressive kyphosis, preserving spinal sagittal alignment. Out of 24 infected disc spaces, 14 achieved complete bony fusion, while the remaining segments displayed no non-osseous healing but maintained segmental stability. In appropriately selected primary spinal infection patients, VSD and percutaneous trans-segmental fixation without bone grafting and with debridement are feasible and warrant further validation in prospective comparative studies. This approach treats the infection, alleviates pain, restores spinal function, and sustains long-term spinal stability, all while eliminating bone graft complications. VSD may enhance angiogenesis and osteogenesis, facilitating spontaneous bone repair of infected vertebrae, thus providing a novel minimally invasive personalized therapy for spinal infection. Trial registration This is a retrospective study conducted from January 2019 to June 2026. Before the prospective study registration (January 2019 to October 2023), three patients did not undergo vertebral interbody fusion. The prospective single-arm study, ChiCTR2300077746, started in November 2023 and involved 20 participants.