Spine Services, Lenox Hill Hospital, New York, NY 10075, USA.
Int Orthop. 2012 Feb;36(2):433-8. doi: 10.1007/s00264-011-1442-0. Epub 2012 Feb 4.
Postoperative spondylodiscitis is a primary infection of the nucleus pulposus with secondary involvement of the cartilaginous endplate and vertebral bone. Although uncommon, postoperative spondylodiscitis causes major morbidity and may be associated with serious long-term sequelae. Several risk factors had been identified, including immunosuppression, obesity, alcohol, smoking, diabetes and malnutrition.
A review of the literature was done to analyse the diagnosis, treatment and prevention of postoperative spondylodiscitis.
We found that the principles of conservative treatment are to establish an accurate microbiological diagnosis, treat with appropriate antibiotics, immobilise the spine, and closely monitor for spinal instability and neurological deterioration. The purpose of surgical treatment is to obtain multiple cultures of bone and soft tissue, perform a thorough debridement of infected tissue, decompress neural structures, and reconstruct the unstable spinal column with bone graft with or without concomitant instrumentation.
Appropriate management requires aggressive medical treatment and, at times, surgical intervention. If recognised early and treated appropriately, a full recovery can often be expected. Therefore, clinicians should be aware of the clinical presentation of such infections to improve patient outcome. A review of the literature was done to advance our understanding of the diagnosis, treatment, prevention and outcome of these infections.
术后椎间盘炎是一种以髓核为原发性感染，软骨终板和椎体骨为继发性感染的疾病。尽管不常见，但术后椎间盘炎会导致严重的发病率，并可能伴有严重的长期后遗症。已经确定了几个危险因素，包括免疫抑制、肥胖、酒精、吸烟、糖尿病和营养不良。
对文献进行了回顾，以分析术后椎间盘炎的诊断、治疗和预防。
我们发现，保守治疗的原则是建立准确的微生物学诊断，用适当的抗生素治疗，固定脊柱，并密切监测脊柱不稳和神经恶化。手术治疗的目的是获得骨和软组织的多次培养，对感染组织进行彻底清创，对受神经结构进行减压，并使用或不使用伴随器械进行骨移植来重建不稳定的脊柱。
适当的治疗需要积极的药物治疗，有时还需要手术干预。如果早期发现并得到适当治疗，通常可以完全康复。因此，临床医生应该了解此类感染的临床表现，以改善患者的预后。对文献的回顾提高了我们对这些感染的诊断、治疗、预防和结果的认识。
