Pola Enrico, Taccari F, Autore G, Giovannenze F, Pambianco V, Cauda R, Maccauro G, Fantoni M
Division of Spine Surgery, Department of Orthopaedics and Traumatology, "A. Gemelli" University Hospital, Catholic University of Rome, 00168, Rome, Italy.
Department of Infectious Diseases, "A. Gemelli" University Hospital, Catholic University of Rome, 00168, Rome, Italy.
Eur Spine J. 2018 Jun;27(Suppl 2):229-236. doi: 10.1007/s00586-018-5598-9. Epub 2018 Apr 17.
Pyogenic spondylodiscitis (PS) is a potentially life-threatening infection burdened by high morbidity rates. Despite the rising incidence, the proper management of PS is still controversial. Aim of this study was to describe the clinical features of PS and to evaluate the prognostic factors and the long-term outcomes of a large population of patients.
207 cases of PS treated from 2008 to 2016 with a 2-year follow-up were enrolled. Clinical data from each patient were recorded. The primary outcome was the rate of healing without residual disability. Secondary outcomes included length of stay, healing from infection, death, relapse, and residual disability. Binomial logistic regression and multivariate analysis were used to evaluate prognostic factors.
Median diagnostic delay was 30 days and the rate of onset neurological impairment was 23.6%. Microbiological diagnosis was established in 155 patients (74.3%) and the median duration of total antibiotic therapy was 148 days. Orthopedic treatment was conservative for 124 patients and surgical in 47 cases. Complete healing without disability was achieved in 142 patients (77.6%). Statistically confirmed negative prognostic factors were: negative microbiological culture, neurologic impairment at diagnosis and underlying endocarditis (p ≤ 0.05). Healing from infection rate was 90.9%, while residual disabilities occurred in 23.5%. Observed mortality rate was 7.8%.
The microbiological diagnosis is the main predictive factor for successful treatment. Early diagnosis and multidisciplinary management are also needed to identify underlying aggressive conditions and to avoid neurological complications associated with poorer long-term outcomes. Despite high healing rates, PS may lead to major disabilities still representing a difficult challenge. These slides can be retrieved under Electronic Supplementary material.
化脓性脊椎间盘炎（PS）是一种潜在的危及生命的感染性疾病，发病率较高。尽管发病率不断上升，但PS的恰当治疗仍存在争议。本研究的目的是描述PS的临床特征，并评估大量患者的预后因素和长期结局。
纳入2008年至2016年治疗的207例PS患者，并进行为期2年的随访。记录每位患者的临床数据。主要结局是无残留残疾的愈合率。次要结局包括住院时间、感染愈合情况、死亡、复发和残留残疾。采用二项逻辑回归和多变量分析评估预后因素。
中位诊断延迟为30天，发病时神经功能障碍发生率为23.6%。155例患者（74.3%）确诊微生物感染，抗生素总治疗时间中位数为148天。124例患者采用保守骨科治疗，47例患者接受手术治疗。142例患者（77.6%）实现完全愈合且无残疾。经统计学确认的不良预后因素为：微生物培养阴性、诊断时神经功能障碍和潜在的心内膜炎（p≤0.05）。感染愈合率为90.9%，而残留残疾发生率为23.5%。观察到的死亡率为7.8%。
微生物诊断是治疗成功的主要预测因素。还需要早期诊断和多学科管理，以识别潜在的侵袭性疾病，并避免与较差长期结局相关的神经并发症。尽管愈合率较高，但PS仍可能导致严重残疾，仍然是一项艰巨的挑战。这些幻灯片可在电子补充材料中获取。
