Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada.
Spine (Phila Pa 1976). 2010 Jun 1;35(13):1316-22. doi: 10.1097/BRS.0b013e3181c0a158.
Retrospective review of consecutive case series.
To evaluate the early surgical results and complications of thoracic transdiscal osteotomies and vertebral shortening for the treatment of thoracic discitis/osteomyelitis.
Thoracic discitis/osteomyelitis leads to collapse of the disc space and/or vertebral body. We propose a novel technique to achieve the same goals as anterior column reconstruction through an entirely posterior approach. Shortening of the vertebral column provides structural support without the morbidity of an anterior approach.
Following REB approval, retrospective review of the charts of five patients that underwent posterior only thoracic transdiscal osteotomies and vertebral shortening for discitis/osteomyelitis was carried out. Posterior only surgery was performed in these patients with excision of the affected disc space and corresponding posterior elements. Instrumented fusion was performed across the segment spanning multiple vertebral levels. Clinical outcome, radiographic correction, and perioperative complications were analyzed.
Three patients had bacterial discitis, and 2 had tuberculosis. Mean age at the time of surgery was 61 years (50-76). Mean follow-up was 45 months (25-63). There was no neurologic deterioration; 2 patients with Frankel grade B improved to grade D and E, respectively. Mean kyphosis corrected from 36 degrees (14-90) to 4 degrees (0-8), and the mean construct spanned 9 levels (6-15). No major complications were encountered during surgery. Two patients underwent revision surgeries, 1 patient died of unrelated causes at 6 months. All patients were treated with a full course of postoperative antibiotic treatment. No cases of recurrent infection were recorded.
Thoracic transdiscal osteotomy with vertebral shortening is a safe and effective option for the treatment of infectious discitis/osteomyelitis with associated kyphosis. With adjuvant antibiotics, it effectively eradicates the infection through a posterior only approach, avoiding the need for anterior procedures and long anterior struts.
回顾性连续病例系列研究。
评估经胸椎间盘切开和椎体缩短治疗胸椎间盘炎/骨髓炎的早期手术结果和并发症。
胸椎间盘炎/骨髓炎可导致椎间盘间隙和/或椎体塌陷。我们提出了一种新的技术，通过完全后路入路达到与前柱重建相同的目标。缩短脊柱提供了结构支撑，而不会出现前路手术的发病率。
在获得 REB 批准后，对 5 例因椎间盘炎/骨髓炎而行单纯后路经胸椎间盘切开和椎体缩短的患者的病历进行了回顾性分析。这些患者仅行后路手术，切除受累椎间盘间隙和相应的后柱。在跨越多个椎体水平的节段上进行器械融合。分析临床结果、影像学矫正和围手术期并发症。
3 例患者为细菌性椎间盘炎，2 例为结核。手术时的平均年龄为 61 岁（50-76 岁）。平均随访时间为 45 个月（25-63 个月）。无神经恶化；2 例 Frankel 分级为 B 的患者分别改善至 D 和 E 级。平均后凸角从 36 度（14-90 度）矫正至 4 度（0-8 度），平均结构跨越 9 个节段（6-15 个节段）。手术过程中未发生重大并发症。2 例患者行翻修手术，1 例患者在术后 6 个月因与治疗无关的原因死亡。所有患者均接受全程术后抗生素治疗。未记录到复发性感染病例。
经胸椎间盘切开和椎体缩短是治疗伴有后凸的感染性椎间盘炎/骨髓炎的安全有效方法。通过单纯后路入路，在辅助使用抗生素的情况下，可有效地根除感染，避免了前路手术和长前路支撑的需要。
