O'Toole John E, Eichholz Kurt M, Fessler Richard G
Department of Neurosurgery, Rush University Medical Center, Chicago, IL 60612, USA.
J Neurosurg Spine. 2009 Oct;11(4):471-6. doi: 10.3171/2009.5.SPINE08633.
Postoperative surgical site infections (SSIs) have been reported after 2-6% of spinal surgeries in most large series. The incidence of SSI can be < 1% after decompressive procedures and > 10% after instrumented fusions. Anecdotal evidence has suggested that there is a lower rate of SSI when minimally invasive techniques are used.
A retrospective review of prospectively collected databases of consecutive patients who underwent minimally invasive spinal surgery was performed. Minimally invasive spinal surgery was defined as any spinal procedure performed through a tubular retractor system. All surgeries were performed under standard sterile conditions with preoperative antibiotic prophylaxis. The databases were reviewed for any infectious complications. Cases of SSI were identified and reviewed for clinically relevant details. The incidence of postoperative SSIs was then calculated for the entire cohort as well as for subgroups based on the type of procedure performed, and then compared with an analogous series selected from an extensive literature review.
The authors performed 1338 minimally invasive spinal surgeries in 1274 patients of average age 55.5 years. The primary diagnosis was degenerative in nature in 93% of cases. A single minimally invasive spinal surgery procedure was undertaken in 1213 patients, 2 procedures in 58, and 3 procedures in 3 patients. The region of surgery was lumbar in 85%, cervical in 12%, and thoracic in 3%. Simple decompressive procedures comprised 78%, instrumented arthrodeses 20%, and minimally invasive intradural procedures 2% of the collected cases. Three postoperative SSIs were detected, 2 were superficial and 1 deep. The procedural rate of SSI for simple decompression was 0.10%, and for minimally invasive fusion/fixation was 0.74%. The total SSI rate for the entire group was only 0.22%.
Minimally invasive spinal surgery techniques may reduce postoperative wound infections as much as 10-fold compared with other large, modern series of open spinal surgery published in the literature.
在大多数大型研究系列中，有报道称2% - 6%的脊柱手术后会发生手术部位感染（SSI）。减压手术后SSI的发生率可能低于1%，而器械融合术后则高于10%。有轶事证据表明，使用微创技术时SSI的发生率较低。
对前瞻性收集的连续接受微创脊柱手术患者的数据库进行回顾性分析。微创脊柱手术定义为通过管状牵开器系统进行的任何脊柱手术。所有手术均在标准无菌条件下进行，并进行术前抗生素预防。对数据库进行审查以查找任何感染并发症。识别出SSI病例并审查其临床相关细节。然后计算整个队列以及根据所执行手术类型划分的亚组的术后SSI发生率，并与从广泛文献综述中选取的类似系列进行比较。
作者对1274例平均年龄55.5岁的患者进行了1338例微创脊柱手术。93%的病例主要诊断为退行性病变。1213例患者进行了单次微创脊柱手术，58例患者进行了2次手术，3例患者进行了3次手术。手术部位为腰椎的占85%，颈椎的占12%，胸椎的占3%。收集的病例中，单纯减压手术占78%，器械融合术占20%，微创硬膜内手术占2%。检测到3例术后SSI，2例为浅表感染，1例为深部感染。单纯减压手术的SSI发生率为0.10%，微创融合/固定手术的发生率为0.74%。整个组的总SSI发生率仅为0.22%。
与文献中发表的其他大型现代开放性脊柱手术系列相比，微创脊柱手术技术可将术后伤口感染减少多达10倍。
