Mastronardi Luciano, Rychlicki Franco, Tatta Carlo, Morabito Letterio, Agrillo Umberto, Ducati Alessandro
Division of Neurosurgery, S. Andrea Hospital, Rome, Italy.
Neurosurg Rev. 2005 Oct;28(4):303-7. doi: 10.1007/s10143-005-0404-7. Epub 2005 Jul 19.
The role of antibiotic prophylaxis in preventing postoperative lumbar spondylodiscitis is still controversial in medical, ethical, economic, and legal terms. The aim of this retrospective study was to evaluate the efficacy of two intraoperative antibiotic prophylaxis protocols in a large series of lumbar microdiscectomies performed in two different neurosurgical centres. We reviewed the outcome of 1167 patients operated on for a lumbar disc herniation with microsurgical technique, in order to detect the incidence of postoperative spondylodiscitis. Group A included 450 patients operated on in a 3-year period in the Neurosurgical Division of the University Hospital of Ancona; group P consisted of 717 patients operated on in a 4-year period in the Neurosurgical Division of the Sandro Pertini Hospital of Rome. In both groups intraoperative antibiotics for prophylaxis were administered, whereas postoperative prophylaxis was not performed. Protocol of group A: single intravenous dose of cefazoline 1 g at induction of general anesthesia and generous washing with saline solution and irrigation with a solution containing rifamicin at the end of microsurgical procedure. Protocol of group P: single-dose of intravenous ampicillin 1000 mg and sulbactam 500 mg at induction of anesthesia and generous irrigation with saline solution at the end of microsurgical procedure. A diagnosis of postoperative spondylodiscitis was made in three out of 450 patients in group A (0.67%) and in 5 out of 717 patients in group P (0.69%). In all cases, treatment consisted of rigid thoraco-lumbar orthesis and 4- to 6-week administration of amoxicillin/clavulanate compound (500/125 mg). The low incidence of postoperative spondylodiscitis obtained with both our protocols seems to confirm that intraoperative antibiotic prophylaxis is associated with the same rate of discitis of prolonged prophylaxis usually still adopted in many centres, but is more advantageous both in terms of welfare and comfort for patients and in economic terms. However, at the moment it is not possible identify the ideal antibiotic for this purpose. It seems to be reasonable to search for the solution through large multicenter prospective studies.
在医学、伦理、经济和法律层面，抗生素预防在预防术后腰椎间盘炎中的作用仍存在争议。这项回顾性研究的目的是评估在两个不同神经外科中心进行的大量腰椎显微椎间盘切除术的两种术中抗生素预防方案的疗效。我们回顾了1167例采用显微外科技术进行腰椎间盘突出症手术患者的结果，以检测术后椎间盘炎的发生率。A组包括在安科纳大学医院神经外科3年期间接受手术的450例患者；P组由在罗马桑德罗·佩尔蒂尼医院神经外科4年期间接受手术的717例患者组成。两组均在术中使用抗生素进行预防，术后未进行预防。A组方案：全身麻醉诱导时静脉注射单剂量头孢唑林1g，显微手术结束时用生理盐水大量冲洗并用含利福霉素的溶液冲洗。P组方案：麻醉诱导时静脉注射单剂量氨苄西林1000mg和舒巴坦500mg，显微手术结束时用生理盐水大量冲洗。A组450例患者中有3例（0.67%）诊断为术后椎间盘炎，P组717例患者中有5例（0.69%）诊断为术后椎间盘炎。所有病例的治疗包括使用硬式胸腰椎矫形器以及服用阿莫西林/克拉维酸复合制剂（500/125mg）4至6周。我们的两种方案获得的术后椎间盘炎低发生率似乎证实，术中抗生素预防与许多中心通常仍采用的长期预防的椎间盘炎发生率相同，但在患者的福利和舒适度以及经济方面更具优势。然而，目前尚无法确定用于此目的的理想抗生素。通过大型多中心前瞻性研究寻找解决方案似乎是合理的。
