Ascione Tiziana, Balato Giovanni, Di Donato Sigismondo Luca, Pagliano Pasquale, Granata Francesco, Colella Gianluca, Ruosi Carlo
Department of Infectious Diseases, D. Cotugno Hospital, AORN dei colli, Naples, Italy.
Department of Public Health, School of Medicine"Federico II" University, Naples, Italy.
Eur Spine J. 2017 Oct;26(Suppl 4):489-495. doi: 10.1007/s00586-017-5036-4. Epub 2017 Mar 17.
Spondylodiscitis refers to infections of the intervertebral disc and the adjacent vertebral body. Although it is still considered a rare condition, its rate is projected to increase. Mortality rate is considered to be low, but an estimated one third of the survivors experience residual disabilities. Literature shows that uncomplicated spondylodiscitis can be adequately treated by early antibiotic therapy and immobilization. The aim of the study is to evaluate the outcome of conservative treatment in patients with haematogenous spondylodiscitis.
All patients with haematogenous spondylodiscitis observed in two orthopaedic centres were retrospectively considered. The medical records, radiologic imaging, bacteriology results, treatment, and complications of all patients were reviewed.
Thirty patients (median age 64 years, range 15-77, females 56.7%) were considered in the study, eight (26.7%) showed residual back pain at median follow-up of 117 weeks (range 104-189). A significant difference in SF-36 physical (P < 0.001), SF-36 mental function (P < 0.002), and Oswestry Disability Index (ODI) (P < 0.001) scores was observed among patients with residual local pain compared to the ones who had not. Methicillin-resistant Staphylococcus aureus (MRSA) infection and symptoms duration before the diagnosis were associated with an increased risk of persistent back pain and permanent disability. The most important negative determinants of SF-36 mental function were the age of patients (ρ = 0.36, P < 0.05), the duration of symptoms before the diagnosis (ρ = 0.44, P < 0.05) and MRSA infection (P = 0.006). Spondylodiscitis sustained by MRSA and the duration of symptoms before the diagnosis influenced negatively the physical status (P = 0.002) and ODI (ρ = 0.36, P < 0.05), respectively.
Conservative approaches are safe and effective for patients without complications. A delayed diagnosis and MRSA infections are related to poor clinical outcome among patients treated by conservative treatment; this must be carried out scrupulously with close patient monitoring.
脊椎椎间盘炎指椎间盘及相邻椎体的感染。尽管其仍被视为罕见病症，但预计发病率会上升。死亡率被认为较低，但估计有三分之一的幸存者会有残留残疾。文献表明，单纯性脊椎椎间盘炎可通过早期抗生素治疗和固定得到充分治疗。本研究的目的是评估血源性脊椎椎间盘炎患者保守治疗的结果。
回顾性分析在两个骨科中心观察到的所有血源性脊椎椎间盘炎患者。查阅了所有患者的病历、影像学检查、细菌学结果、治疗情况及并发症。
本研究纳入30例患者（中位年龄64岁，范围15 - 77岁，女性占56.7%），8例（26.7%）在中位随访117周（范围104 - 189周）时仍有残留背痛。与无残留局部疼痛的患者相比，有残留局部疼痛的患者在SF - 36身体功能（P < 0.001）、SF - 36心理功能（P < 0.002）和奥斯维斯特残疾指数（ODI）（P < 0.001）评分上存在显著差异。耐甲氧西林金黄色葡萄球菌（MRSA）感染及诊断前症状持续时间与持续性背痛和永久性残疾风险增加相关。SF - 36心理功能最重要的负性决定因素是患者年龄（ρ = 0.36，P < 0.05）、诊断前症状持续时间（ρ = 0.44，P < 0.05）和MRSA感染（P = 0.006）。MRSA引起的脊椎椎间盘炎和诊断前症状持续时间分别对身体状况（P = 0.002）和ODI（ρ = 0.36，P < 0.05）产生负面影响。
对于无并发症患者，保守治疗方法安全有效。延迟诊断和MRSA感染与保守治疗患者的不良临床结局相关；必须在密切监测患者的情况下谨慎进行保守治疗。
