Hsu Li-Chen, Tseng Tzu-Ming, Yang Shih-Chieh, Chen Hung-Shu, Yen Cheng-Yo, Tu Yuan-Kun
Orthopedics. 2015 Oct;38(10):e856-63. doi: 10.3928/01477447-20151002-50.
Common management approaches for spinal infections include conservative administration of antibiotics and aggressive surgical debridement. Minimally invasive endoscopic treatment has been reported and is gaining widespread attention because of its simplicity and effectiveness. This study retrospectively evaluated the clinical outcomes of bilateral portal percutaneous endoscopic debridement and lavage with dilute povidone-iodine solution in the treatment of patients with lumbar pyogenic spondylitis. From January 2007 to December 2011, a total of 22 patients diagnosed with single-level lumbar pyogenic spondylitis underwent bilateral portal percutaneous endoscopic debridement and lavage with dilute povidone-iodine solution at the authors' institution. Clinical outcomes were assessed by careful physical examination, visual analog scale pain score, modified MacNab criteria functional score, regular serologic testing, and imaging studies to determine whether percutaneous endoscopic debridement and lavage treatment was successful or if surgical intervention was required. Causative bacteria were identified in 19 (86.4%) of 22 biopsy specimens. Eighteen patients had satisfactory relief of back pain and uneventful recovery after this treatment. The success rate was 81.8% (18 of 22). Both visual analog scale and modified MacNab criteria scores improved significantly in successfully treated patients. No major surgical complications were noted, except for 3 patients who had residual or subsequent paresthesia in the affected lumbar segment. Percutaneous endoscopic debridement and lavage is a minimally invasive procedure that can yield a higher bacterial diagnosis, relieve back pain, and help to eradicate lumbar pyogenic spondylitis. It is an effective alternative treatment for patients with spinal infection before extensive open surgery.
脊柱感染的常见管理方法包括抗生素的保守使用和积极的手术清创。微创内镜治疗已有报道，并因其简便性和有效性而受到广泛关注。本研究回顾性评估了双侧经皮内镜清创及用稀释聚维酮碘溶液灌洗治疗腰椎化脓性脊柱炎患者的临床疗效。2007年1月至2011年12月，共有22例被诊断为单节段腰椎化脓性脊柱炎的患者在作者所在机构接受了双侧经皮内镜清创及用稀释聚维酮碘溶液灌洗。通过仔细的体格检查、视觉模拟评分法疼痛评分、改良MacNab标准功能评分、定期血清学检测和影像学研究来评估临床疗效，以确定经皮内镜清创及灌洗治疗是否成功或是否需要手术干预。在22份活检标本中，19份（86.4%）鉴定出了致病细菌。18例患者经此治疗后背痛得到满意缓解且恢复顺利。成功率为81.8%（22例中的18例）。成功治疗的患者视觉模拟评分和改良MacNab标准评分均显著改善。除3例在受累腰椎节段有残留或随后出现感觉异常外，未发现重大手术并发症。经皮内镜清创及灌洗是一种微创手术，可提高细菌诊断率、缓解背痛并有助于根除腰椎化脓性脊柱炎。对于脊柱感染患者，在进行广泛的开放手术之前，它是一种有效的替代治疗方法。
