Homagk L, Homagk N, Klauss J R, Roehl K, Hofmann G O, Marmelstein D
Centre for Spinal Cord Injuries, BG-Kliniken Bergmannstrost, Halle (Saale), Germany.
Asklepios Clinic Weißenfels, Naumburger Straße 76, 06667, Weißenfels, Germany.
Eur Spine J. 2016 Apr;25(4):1012-20. doi: 10.1007/s00586-015-3936-8. Epub 2015 Apr 21.
Established treatment options of spondylodiscitis, a rare but serious infection of the spine, are immobilization and systemic antibiosis. However, the available data for specific treatment recommendations are very heterogeneous. Our intention was to develop a classification of the severity of spondylodiscitis with appropriate treatment recommendations.
From 10/1/1998 until 12/31/2004, 37 cases of spondylodiscitis were examined regarding medical history, gender status, location and extent of spondylodiscitis, type and number of operations. Subsequently, a classification of six grades according to severity has been developed with specific treatment recommendations. The further evaluation of our classification and corresponding treatment modalities from 1/1/2005 to 12/31/2009 including further 132 cases, resulted in a classification of only three grades of severity (the SSC--spondylodiscitis severity code), with a follow-up until 12/31/2011. Between 01/01/2012 and 12/31/2013, a prospective study of 42 cases was carried out. Overall, 296 cases were included in the study. 26 conservatively treated cases were excluded.
The main localization of spondylodiscitis was the lumbar spine (55%) followed by the thoracic spine (34%). The classification of patients into 3 grades of severity depends on clinical and laboratory parameters, the morphological vertebral destruction seen in radiological examinations and the current neurological status. Therapies are adapted according to severity and they include a specific surgical management, systemic antibiotic therapy according to culture and sensitivity tests, physiotherapy and initiation of post-hospital follow-up. 40.6% of patients are associated with neurological deficits, classified as severity grade 3 and treated surgically with spinal stabilization and decompression. 46.9% of patients corresponded to severity grade 2, with concomitant vertebral destruction were dorsoventrally stabilized. The 31 patients of severity Grade 1 were treated surgically with dorsal stabilization. From 1998 to 2013, the time from the onset of symptoms to the first surgical treatment was about 69.4 days and has not changed significantly. However, the time from admission to surgical treatment had been reduced to less than 2 days. Also the time of hospitalization was reduced and we see positive effects regarding the sensation of pain. 270 patients underwent surgery. We treated 89% dorsally and 21% dorsoventrally. With the spondylodiscitis severity code, a classification of the severity of spondylodiscitis could be established and used for a severity-based treatment. In addition, specific parameters for the treatment of individual grades of severity can be determined in a clinical pathway.
脊柱椎间盘炎是一种罕见但严重的脊柱感染，既定的治疗方法是固定制动和全身抗感染治疗。然而，关于具体治疗建议的现有数据非常不一致。我们的目的是制定一种脊柱椎间盘炎严重程度分类方法及相应的治疗建议。
从1998年10月1日至2004年12月31日，对37例脊柱椎间盘炎患者进行了病史、性别状况、脊柱椎间盘炎的部位和范围、手术类型及数量等方面的检查。随后，根据严重程度制定了一个六级分类方法及具体治疗建议。对2005年1月1日至2009年12月31日包括另外132例患者在内的分类及相应治疗方式进行进一步评估，最终形成了一个仅包含三个严重程度等级的分类方法（脊柱椎间盘炎严重程度编码，即SSC），随访至2011年12月31日。2012年1月1日至2013年12月31日，对42例患者进行了前瞻性研究。总体而言，该研究共纳入296例患者。排除26例保守治疗的病例。
脊柱椎间盘炎的主要发病部位是腰椎（55%），其次是胸椎（34%）。将患者分为三个严重程度等级取决于临床和实验室参数、放射学检查中可见的椎体形态破坏以及当前的神经功能状态。治疗方法根据严重程度进行调整，包括特定的手术治疗、根据培养和药敏试验进行的全身抗生素治疗、物理治疗以及出院后随访的启动。40.6%的患者伴有神经功能缺损，被归类为严重程度3级，接受了脊柱稳定和减压手术治疗。46.9%的患者对应严重程度2级，伴有椎体破坏，进行了前后路稳定手术。31例严重程度1级的患者接受了后路稳定手术。从1998年到2013年，从症状出现到首次手术治疗的时间约为69.4天，且无显著变化。然而，从入院到手术治疗的时间已缩短至不到2天。住院时间也有所缩短，并且我们看到在疼痛感觉方面有积极效果。270例患者接受了手术。我们进行了89%的后路手术和21%的前后路手术。通过脊柱椎间盘炎严重程度编码，可以建立脊柱椎间盘炎严重程度的分类，并用于基于严重程度的治疗。此外，可以在临床路径中确定针对各个严重程度等级的具体治疗参数。
