Tschugg Anja, Hartmann Sebastian, Lener Sara, Rietzler Andreas, Sabrina Neururer, Thomé Claudius
Department of Neurosurgery, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria.
Eur Spine J. 2017 Dec;26(12):3141-3146. doi: 10.1007/s00586-017-5180-x. Epub 2017 Jun 12.
Minimally invasive surgical techniques have been developed to minimize tissue damage, reduce narcotic requirements, decrease blood loss, and, therefore, potentially avoid prolonged immobilization. Thus, the purpose of the present retrospective study was to assess the safety and efficacy of a minimally invasive posterior approach with transforaminal lumbar interbody debridement and fusion plus pedicle screw fixation in lumbar spondylodiscitis in comparison to an open surgical approach. Furthermore, treatment decisions based on the patient´s preoperative condition were analyzed.
67 patients with lumbar spondylodiscitis treated at our department were included in this retrospective analysis. The patients were categorized into two groups based on the surgical procedure: group (MIS) minimally invasive lumbar spinal fusion (n = 19); group (OPEN) open lumbar spinal fusion (n = 48). Evaluation included radiological parameters on magnetic resonance imaging (MRI), laboratory values, and clinical outcome.
Preoperative MRI showed higher rates of paraspinal abscess (35.5 vs. 5.6%; p = 0.016) and multilocular location in the OPEN group (20 vs. 0%, p = 0.014). Overall pain at discharge was less in the MIS group: NRS 2.4 ± 1 vs. NRS 1.6 ± 1 (p = 0.036). The duration of hospital stay was longer in the OPEN than the MIS group (19.1 ± 12 days vs. 13.7 ± 5 days, p = 0.018).
The open technique is effective in all varieties of spondylodiscitis inclusive in epidural abscess formation. MIS can be applied safely and effectively as well in selected cases, even with epidural abscess.
已开发出微创外科技术，以尽量减少组织损伤、减少麻醉药物需求、减少失血，从而有可能避免长期制动。因此，本回顾性研究的目的是评估与开放手术方法相比，微创后路经椎间孔腰椎椎体间清创融合加椎弓根螺钉固定治疗腰椎化脓性脊柱炎的安全性和有效性。此外，还分析了基于患者术前状况的治疗决策。
本回顾性分析纳入了在我科接受治疗的67例腰椎化脓性脊柱炎患者。根据手术方式将患者分为两组：微创腰椎融合组（MIS，n = 19）；开放腰椎融合组（OPEN，n = 48）。评估包括磁共振成像（MRI）的影像学参数、实验室检查值和临床结果。
术前MRI显示，开放组椎旁脓肿发生率较高（35.5% 对5.6%；p = 0.016），且多房性病变发生率较高（20% 对0%，p = 0.014）。出院时MIS组总体疼痛较轻：数字疼痛评分法（NRS）为2.4 ± 1，而开放组为1.6 ± 1（p = 0.036）。开放组住院时间比MIS组长（19.1 ± 12天对13.7 ± 5天，p = 0.0
