Tsai Tsung-Ting, Yang Shih-Chieh, Niu Chi-Chien, Lai Po-Liang, Lee Ming-Hsun, Chen Lih-Huei, Chen Wen-Jer
Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 5, Fusing St., Gueishan, Taoyuan, 333, Taiwan.
Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
BMC Musculoskelet Disord. 2017 Apr 27;18(1):175. doi: 10.1186/s12891-017-1533-1.
Pyogenic spondylodiscitis is a form of spinal infection that can result in severe back pain and even death. However, information is lacking on the relative effectiveness of various therapies. A retrospective chart review was conducted to investigate whether early surgical treatment of pyogenic spondylodiscitis coupled with intravenous antibiotics results in better patient prognoses than intravenous antibiotics therapy alone.
All patients treated for pyogenic spondylodiscitis at a single medical center from July 2006 to July 2011 were retrospectively reviewed. The inclusion criteria consisted of diagnosis of an early stage infection without neurological deficit, and patients without severe sepsis who were suitable candidates for early surgery as determined by a Pittsburgh bacteremia score < 4, and patients with delayed diagnosis and lost to outpatient follow-up were excluded. Clinical outcomes included patient demographic data, kyphosis angle, length of treatment, Oswestry Disability Index and visual analogue pain scale were analyzed.
Of 90 enrolled patients, Group 1 (n = 47) received only antibiotic therapy and Group 2 (n = 43) received early surgery with post-surgery antibiotics for 2 to 4 weeks. Group 2 exhibited significantly better results than Group 1 for mean antibiotic administration period, mean hospitalization period, kyphotic angle correction. Of 61 patients who participated in telephone follow-up after discharge, Group 2 (n = 26) had significant lower mean ODI score, and mean back pain score than Group 1 (n = 35).
While infection control was similar for both groups, patients treated with early surgery and antibiotics were hospitalized for fewer days and required less antibiotics than those treated with antibiotics alone, also having better functional outcomes. In short, early surgical treatment of pyogenic spondylodiscitis typically achieves a better prognosis, shorter hospitalization period, and subsequent significant improvement in kyphotic deformity and quality of life.
化脓性脊椎间盘炎是一种脊柱感染形式，可导致严重背痛甚至死亡。然而，关于各种治疗方法的相对有效性的信息却很缺乏。进行了一项回顾性病历审查，以调查化脓性脊椎间盘炎的早期手术治疗联合静脉使用抗生素是否比单纯静脉使用抗生素治疗能带来更好的患者预后。
对2006年7月至2011年7月在单个医疗中心接受化脓性脊椎间盘炎治疗的所有患者进行回顾性审查。纳入标准包括诊断为无神经功能缺损的早期感染，匹兹堡菌血症评分<4确定为适合早期手术的无严重脓毒症患者，排除诊断延迟和失访的门诊患者。分析临床结果，包括患者人口统计学数据、后凸角、治疗长度、奥斯威斯功能障碍指数和视觉模拟疼痛量表。
90名入组患者中，第1组（n = 47）仅接受抗生素治疗，第2组（n = 43）接受早期手术并术后使用抗生素2至4周。第2组在平均抗生素给药期、平均住院期、后凸角矫正方面的结果明显优于第1组。在61名出院后参与电话随访的患者中，第2组（n = 26）的平均ODI评分和平均背痛评分明显低于第1组（n = 35）。
虽然两组的感染控制相似，但与仅接受抗生素治疗的患者相比，接受早期手术和抗生素治疗的患者住院天数更少，所需抗生素更少，功能结局也更好。简而言之，化脓性脊椎间盘炎的早期手术治疗通常能获得更好的预后、更短的住院期，并随后使后凸畸形和生活质量得到显著改善。
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