Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, 5 Fu-Hsin St., Kweishan, Taoyuan, Taiwan 333, Republic of China.
Spine J. 2011 Jan;11(1):24-9. doi: 10.1016/j.spinee.2010.10.021.
Postoperative wound infection is a well-recognized complication of spinal surgery. The infection occurs usually at the posterior wound after posterior spinal surgery. To the best of our knowledge, no report exists regarding treatment of anterior spondylodiscitis after posterior pedicle screw instrumentation.
Audit of our protocols for the diagnosis and management of anterior spondylodiscitis after posterior pedicle screw instrumentation.
STUDY DESIGN/SETTING: A retrospective study of patients with anterior spondylodiscitis after posterior pedicle screw instrumentation, who received treatment accordingly.
Eleven patients were included.
The outcomes were evaluated clinically by the Oswestry Disability Index (ODI) and visual analog scale (VAS). The status of the anterior fusion was assessed according to the Bridwell grading system. Eradication of infection was determined by the level of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).
From 1997 to 2008, 6,120 patients with degenerative spinal diseases and osteoporotic spine fractures were treated with posterolateral-instrumented fusion, and postoperative posterior infection was found in 135 (2.2%) patients. Postoperative anterior spondylodiscitis was noted in 11 patients. The 11 patients with anterior spondylodiscitis after posterior pedicle screw instrumentation underwent combined posterior surgery and anterior debridement with fusion simultaneously or in staged operations. The clinical outcomes were evaluated by the ODI and VAS. The status of the anterior fusion was assessed according to the Bridwell grading system. Eradication of infection was determined by the level of CRP and ESR.
Postoperative anterior infection was diagnosed between 2 and 36 months (average, 14.8 months) after posterior surgery. The average period of recurrent axial pain and the diagnosis of infection was 19.7 weeks (2-24 weeks). The mean ESR was 66.4 mm/h (range, 20-95 mm/h) and CRP was 52.7 mg/L (range, 8.4-129 mg/L). All patients received parenteral antibiotics for 4 to 6 weeks, followed by oral antibiotics for a total of 3 months according to sensitivity tests after surgery. All patients had complete eradication of infection. The mean VAS improved from 7.9 preoperatively to 2.0 postoperatively. The mean ODI score improved from 44 to 21.1. Based on the Bridwell anterior fusion grading system, nine (82%) patients achieved Grade I fusion and two (18%) patients achieved Grade II fusion.
Anterior spine infection may occur after posterior pedicle screw instrumentation. Eleven patients with anterior spondylodiscitis, which developed after posterior pedicle screw instrumentation, were successfully treated by combined posterior surgery and anterior debridement with fusion simultaneously or in staged operations.
Level IV, case series study.
术后伤口感染是脊柱手术的一种公认的并发症。感染通常发生在后路脊柱手术后的后伤口。据我们所知，尚无关于后路椎弓根螺钉固定术后前路脊椎炎的治疗报告。
审核我们诊断和治疗后路椎弓根螺钉固定术后前路脊椎炎的方案。
研究设计/设置：回顾性研究接受相应治疗的后路椎弓根螺钉固定术后前路脊椎炎患者。
共纳入 11 例患者。
采用 Oswestry 残疾指数（ODI）和视觉模拟评分（VAS）进行临床评估。根据 Bridwell 分级系统评估前路融合的状态。通过 C 反应蛋白（CRP）和红细胞沉降率（ESR）的水平确定感染的消除情况。
1997 年至 2008 年，对 6120 例退行性脊柱疾病和骨质疏松性脊柱骨折患者进行后路外侧融合治疗，术后发现 135 例（2.2%）患者发生后感染。后路椎弓根螺钉固定术后发现 11 例前路脊椎炎。11 例后路椎弓根螺钉固定术后前路脊椎炎患者同时或分期进行后路手术和前路清创融合治疗。采用 ODI 和 VAS 评估临床疗效。根据 Bridwell 分级系统评估前路融合的状态。通过 CRP 和 ESR 的水平确定感染的消除情况。
术后前路感染发生在后路手术后 2 至 36 个月（平均 14.8 个月）。复发性轴向疼痛和感染诊断的平均时间为 19.7 周（2-24 周）。平均 ESR 为 66.4mm/h（范围 20-95mm/h），CRP 为 52.7mg/L（范围 8.4-129mg/L）。所有患者均接受了 4 至 6 周的静脉抗生素治疗，然后根据术后药敏试验口服抗生素治疗 3 个月。所有患者均完全消除了感染。平均 VAS 从术前的 7.9 分改善至术后的 2.0 分。平均 ODI 评分从 44 分改善至 21.1 分。根据 Bridwell 前路融合分级系统，9 例（82%）患者达到Ⅰ级融合，2 例（18%）患者达到Ⅱ级融合。
后路椎弓根螺钉固定后可能发生前路脊柱感染。后路椎弓根螺钉固定术后发生的 11 例前路脊椎炎患者通过同时或分期后路手术和前路清创融合治疗获得成功。
IV 级，病例系列研究。
