Moon Myung-Sang, Kim Sung-Soo, Lee Bong-Jin, Moon Jeong-Lim, Sihn Jang-Cheol, Moon Seog In
Department of Orthopedic Surgery, Cheju Halla General Hospital, Jeju, Korea.
J Orthop Surg (Hong Kong). 2012 Apr;20(1):11-7. doi: 10.1177/230949901202000103.
To assess the treatment outcome for disc infection in 35 patients.
Records of 23 men and 12 women aged 36 to 62 (mean, 43) years who underwent treatment for pyogenic discitis after open discectomy were reviewed. All patients had single-level disc herniation of L4-5 (n=28) or L5-S1 (n=6), except for one who had 2-level disc herniation of L4-S1. Single antibiotic was given one day prior to discectomy and continued for 2 days. All excised discs were found to be sterile. Discitis was classified into acute (n=26), subacute (n=7), and chronic (n=2). Antibiotic therapy was started immediately when the clinical diagnosis was made. 31 patients were treated with antibiotics alone; the remaining 4 underwent surgery entailing simple posterior superficial wound drainage (n=1), anterior radical surgery (n=2), or posterior instrumentation and posterolateral fusion for post-discectomy syndrome (n=1). Six of the 12 patients who had percutaneous disc space aspiration underwent disc space irrigation.
The initial symptoms included mild-to-moderate fever (n=4), severe back pain (n=27), back muscle spasms (n=26), back pain radiating to the limb (n=2), Gower sign (n=11), and a draining wound (n=1). The wound aspirates of the 12 patients grew organisms, although blood cultures were negative in all. After antibiotic therapy, symptoms gradually subsided in parallel with normalisation of white blood cell count and inflammatory markers. Surgery was indicated only when symptoms worsened and the disease progressed. Spontaneous intercorporal fusion did not occur.
Early diagnosis and treatment with appropriate antibiotics is important for post-discectomy discitis.
评估35例椎间盘感染患者的治疗结果。
回顾性分析23例男性和12例女性患者的病历，年龄36至62岁（平均43岁），这些患者在开放性椎间盘切除术后接受了化脓性椎间盘炎的治疗。除1例为L4 - S1双节段椎间盘突出外，所有患者均为L4 - 5单节段椎间盘突出（n = 28）或L5 - S1单节段椎间盘突出（n = 6）。在椎间盘切除术1天前给予单一抗生素，并持续使用2天。所有切除的椎间盘均无菌。椎间盘炎分为急性（n = 26）、亚急性（n = 7）和慢性（n = 2）。临床诊断一旦确立，立即开始抗生素治疗。31例患者仅接受抗生素治疗；其余4例接受了手术，包括单纯后外侧浅表伤口引流（n = 1）、前路根治性手术（n = 2）或用于椎间盘切除术后综合征的后路内固定和后外侧融合术（n = 1）。12例行经皮椎间盘间隙穿刺抽吸的患者中有6例进行了椎间盘间隙冲洗。
初始症状包括轻度至中度发热（n = 4）、严重背痛（n = 27）、背部肌肉痉挛（n = 26）、放射至肢体的背痛（n = 2）、Gower征（n = 11）和引流伤口（n = 1）。12例患者的伤口抽吸物培养出微生物，尽管所有患者的血培养均为阴性。抗生素治疗后，症状随着白细胞计数和炎症标志物的正常化而逐渐缓解。仅在症状恶化且疾病进展时才进行手术。未发生自发椎间融合。
早期诊断并使用适当的抗生素治疗对椎间盘切除术后椎间盘炎很重要。
