Kao Fu-Cheng, Tsai Tsung-Ting, Niu Chi-Chien, Lai Po-Liang, 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, Taoyuan, Taiwan.
Medicine (Baltimore). 2017 Oct;96(42):e8352. doi: 10.1097/MD.0000000000008352.
Treating thoracic infective spondylodiscitis with anterior surgical approaches carry a relatively high risk of perioperative and postoperative complications. Posterior approaches have been reported to result in lower complication rates than anterior procedures, but more evidence is needed to demonstrate the safety and efficacy of 1-stage posterior approaches for treating infectious thoracic spondylodiscitis.Preoperative and postoperative clinical data, of 18 patients who underwent 2 types of 1-stage posterior procedures, costotransversectomy and transforaminal thoracic interbody debridement and fusion and 7 patients who underwent anterior debridement and reconstruction with posterior instrumentation, were retrospectively assessed.The clinical outcomes of patients treated with 1-stage posterior approaches were generally good, with good infection control, back pain relief, kyphotic angle correction, and either partial or solid union for fusion status. Furthermore, they achieved shorter surgical time, fewer postoperative complications, and shorter hospital stay than the patients underwent anterior debridement with posterior instrumentation.The results suggested that treating thoracic spondylodiscitis with a single-stage posterior approach might prevent postoperative complications and avoid respiratory problems associated with anterior approaches. Single-stage posterior approaches would be recommended for thoracic spine infection, especially for patients with medical comorbidities.
采用前路手术治疗胸椎感染性脊椎椎间盘炎会带来相对较高的围手术期和术后并发症风险。据报道，后路手术的并发症发生率低于前路手术，但仍需要更多证据来证明一期后路手术治疗感染性胸椎脊椎椎间盘炎的安全性和有效性。回顾性评估了18例行两种一期后路手术（肋骨横突切除术和经椎间孔胸椎椎间融合术）的患者以及7例行前路清创联合后路内固定重建术的患者的术前和术后临床数据。接受一期后路手术治疗的患者临床结果总体良好，感染得到有效控制，背痛缓解，后凸角得到矫正，融合状态达到部分或牢固融合。此外，与接受前路清创联合后路内固定的患者相比，他们的手术时间更短，术后并发症更少，住院时间更短。结果表明，采用一期后路手术治疗胸椎脊椎椎间盘炎可能预防术后并发症，并避免与前路手术相关的呼吸问题。对于胸椎感染，尤其是有内科合并症的患者，建议采用一期后路手术。
