Department of Orthopedic Surgery, School of Medicine, National Yang Ming University, Taipei, Taiwan, Republic of China.
Spine (Phila Pa 1976). 2012 Dec 1;37(25):E1572-9. doi: 10.1097/BRS.0b013e31827399b8.
A single-institution, single-surgeon retrospective review.
To evaluate the clinical results of long posterior instrumentation with short posterior or posterolateral fusion for pyogenic spondylodiscitis of the thoracic and lumbar spine retrospectively.
There are controversies concerning the optimal treatment for pyogenic spondylodiscitis, in terms of approach, grafting, and instrumentation. Reports of long posterior fixation with short fusion without debridement of infected tissue for pyogenic spondylodiscitis are rare.
From June 1997 to June 2007, 48 patients with pyogenic spondylodiscitis were treated. The indications for surgery were neurological compromise, significant vertebral body destruction with kyphosis and segmental instability, failure of medical treatment, and the need for tissue diagnosis. All patients received long posterior instrumentation with or without posterior decompression, depending on whether the patients had neurological deficit. During operation, no debridement of infected tissue was done. Clinical outcomes were assessed using the criteria of Kirkaldy-Willis and the visual analogue scale for pain. The neurological outcome was graded using Frankel grading system. Segmental kyphotic angle and fusion were recorded and analyzed.
The average follow-up time was 64 months. The visual analogue scale scores improved from an average of 7.2 before surgery to 2.2 after surgery. Twenty-eight patients with initial neurological impairment had an average improvement of 1.03 grades, using the Frankel grading system, at the final follow-up. The segmental kyphotic deformity improved by an average of 8.5° immediately after operation and lost an average correction of 3.0° at the final follow-up. No relapse of infection was found among these 48 patients.
The posterior approach with long segmental fixation and short posterior or posterolateral fusion without debridement of the infected tissue was effective for pyogenic spondylodiscitis of the thoracic and lumbar spine.
单机构、单外科医生回顾性研究。
回顾性评估长节段后路固定结合短节段后路或后外侧融合治疗胸腰椎化脓性椎间盘炎的临床结果。
在化脓性椎间盘炎的治疗方面，手术入路、植骨和内固定存在争议。对于化脓性椎间盘炎，不清除感染组织而采用长节段后路固定结合短节段融合的报道较少。
1997 年 6 月至 2007 年 6 月，治疗了 48 例化脓性椎间盘炎患者。手术适应证为神经功能障碍、椎体严重破坏伴后凸畸形和节段不稳定、药物治疗失败以及需要组织学诊断。所有患者均接受了后路长节段固定，是否行后路减压取决于患者是否有神经功能缺损。术中不清除感染组织。采用 Kirkaldy-Willis 标准和疼痛视觉模拟评分评估临床疗效。采用 Frankel 分级系统对神经功能恢复进行分级。记录并分析节段后凸角和融合情况。
平均随访时间为 64 个月。视觉模拟评分从术前的平均 7.2 分改善至术后的 2.2 分。28 例初发神经功能障碍患者，Frankel 分级系统平均改善 1.03 级。术后即刻，节段后凸畸形平均改善 8.5°，末次随访时平均丢失矫正 3.0°。48 例患者均未发现感染复发。
对于胸腰椎化脓性椎间盘炎，后路长节段固定结合短节段后路或后外侧融合，不清除感染组织，是一种有效的治疗方法。
