Suess O, Weise L, Brock M, Kombos T
Neurosurgical Clinic, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Zentralbl Neurochir. 2007 Aug;68(3):123-32. doi: 10.1055/s-2007-984461. Epub 2007 Jul 30.
The best surgical technique for patients with bacterial spinal infections is still discussed controversially. But recent publications suggest that titanium implants can be used safely in infectious sites in combination with debridement and antibiotic therapy. The purpose of this study is to provide further evidence in support of debridement and instrumentation as a single-stage procedure for spinal infection.
Twenty-four cases with cervical, thoracic, and lumbar spondylitis/spondylodiscitis were analyzed. In 17 cases, anterolateral stabilization was performed with titanium cages. No autologous or homologous bone grafts were used. Transpedicular screw/rod fixation following posterior debridement of the intervertebral space was performed in the other 7 cases.
WBC and C-reactive protein levels decreased significantly after surgical debridement. Pain levels decreased from a preoperative median of 4 (on the Denis Pain Scale) to a postoperative median of 2. Twenty-two of the 24 patients were fully mobilized within 2 weeks after surgery. The Barthel Index improved from 60 (10-85) before surgery to 90 (65-100) after surgery. No recurrence of the initial infection was noticed during a mean follow-up period of 18 months. The fusion rate was 90.5%. The mortality rate was 1 out of 24 (4.2%).
These findings support the position that debridement and instrumented fusion can be performed as a single-stage procedure without an increase in the recurrence rate or morbidity, compared with the use of autologous bone grafting or staged procedures. Same-stage instrumentation allows early postoperative mobilization of the patient, which is advantageous, especially for an increasingly elderly population and in patients with comorbidities.
细菌性脊柱感染患者的最佳手术技术仍存在争议。但近期的出版物表明，钛植入物可与清创术和抗生素治疗联合安全用于感染部位。本研究的目的是提供进一步证据支持清创术和内固定作为脊柱感染的一期手术。
分析24例颈椎、胸椎和腰椎脊柱炎/脊椎椎间盘炎患者。17例患者采用钛笼进行前外侧稳定术。未使用自体或异体骨移植。另外7例患者在椎间孔后外侧清创术后采用椎弓根螺钉/棒固定。
手术清创后白细胞和C反应蛋白水平显著下降。疼痛程度从术前Denis疼痛量表中位数4降至术后中位数2。24例患者中有22例在术后2周内完全恢复活动。Barthel指数从术前的60（10 - 85）提高到术后的90（65 - 100）。在平均18个月的随访期内未发现初始感染复发。融合率为90.5%。死亡率为24例中的1例（4.2%）。
这些发现支持以下观点，即与使用自体骨移植或分期手术相比，清创术和器械融合术可作为一期手术进行，而不会增加复发率或发病率。同期内固定允许患者术后早期活动，这是有利的，特别是对于日益老龄化的人群和患有合并症的患者。
