Ghobrial George M, Franco Daniel, Theofanis Thana, Margiotta Philip J, Andrews Edward, Wilson Jefferson R, Harrop James S, Heller Joshua E
Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA; Department of Neurological Surgery, University of Miami Hospital, Lois Pope Life Center, Miami, Florida, USA.
Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
World Neurosurg. 2017 Jul;103:664-670. doi: 10.1016/j.wneu.2017.04.119. Epub 2017 Apr 27.
Cervical spondylodiscitis is thought to carry a significant risk for rapid neurologic deterioration with a poor response to nonsurgical management.
A retrospective surgical case series of the acute surgical management of cervical spondylodiscitis is reviewed to characterize the neurologic presentation and postoperative neurologic course in a relatively uncommon disease.
Fifty-nine patients were identified (mean age, 59 years [range, 18-83 years; SD ± 13.2 years]) from a single-institution neurosurgical database. The most common levels of radiographic cervical involvement were C4-C5, C5-C6, and C6-C7, in descending order. Overall, statistically significant clinical improvement was noted after surgery (P < 0.05). Spinal cord hyperintensity on T2-weighted magnetic resonance imaging was significantly associated with a worse preoperative neurologic grade (P = 0.036), but did not correlate with a relatively worse neurologic outcome by discharge. No significant difference was noted between potential preoperative predictors (organism cultured, presence of epidural abscess, tobacco use, early surgery within 24 hours of clinical presentation) and preoperative American Spinal Injury Association injury scale, with the exception of the duration between symptom onset and surgical intervention. A negative correlation between increased preoperative duration of symptoms and magnitude in motor improvement was observed. Relative to anteroposterior decompression and fusion, anterior treatment alone demonstrated a relatively greater effect in neurologic improvement.
Cervical spondylodiscitis is a rare disease that typically manifests with preoperative motor deficits. Surgery was associated with a significant improvement in motor score by hospital discharge. Significant predictors of neurologic improvement were not observed. Prolonged symptomatic duration was correlated with a significantly lower likelihood of motor score improvement.
颈椎椎间盘炎被认为具有神经功能快速恶化的重大风险，且非手术治疗反应不佳。
回顾一项颈椎椎间盘炎急性手术治疗的回顾性手术病例系列，以描述这种相对罕见疾病的神经学表现和术后神经学病程。
从单一机构的神经外科数据库中识别出59例患者（平均年龄59岁[范围18 - 83岁；标准差±13.2岁]）。影像学上颈椎受累最常见的节段依次为C4 - C5、C5 - C6和C6 - C7。总体而言，术后观察到有统计学意义的临床改善（P < 0.05）。T2加权磁共振成像上的脊髓高信号与术前较差的神经学分级显著相关（P = 0.036），但与出院时相对较差的神经学结果无关。除症状出现至手术干预的持续时间外，术前潜在预测因素（培养出的病原体、硬膜外脓肿的存在、吸烟、临床表现24小时内早期手术）与术前美国脊髓损伤协会损伤量表之间未观察到显著差异。观察到术前症状持续时间增加与运动改善程度之间呈负相关。相对于前后路减压融合术，单纯前路治疗在神经学改善方面显示出相对更大的效果。
颈椎椎间盘炎是一种罕见疾病，通常表现为术前运动功能缺损。手术与出院时运动评分的显著改善相关。未观察到神经学改善的显著预测因素。症状持续时间延长与运动评分改善的可能性显著降低相关。
