Chang Chia-Wei, Tsai Tsung-Ting, Niu Chi-Chien, Fu Tsai-Sheng, 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; Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan.
Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
World Neurosurg. 2019 Jan;121:e755-e760. doi: 10.1016/j.wneu.2018.09.211. Epub 2018 Oct 9.
Traditionally, nonoperative management with long-term antibiotics and bed rest has been recommended as first-line treatment for most patients with postoperative discitis. A recent trend in treatment under a limited range of indications has been to perform surgical débridement followed by long-term administration of antibiotics. This descriptive study investigated whether transforaminal lumbar interbody débridement and fusion (TLIDF) combined with intravenous antibiotics is appropriate to manage postdiscectomy discitis.
This study retrospectively analyzed demographic data, laboratory data, and radiography and magnetic resonance imaging of 10 patients with postoperative discitis who underwent surgical TLIDF followed by antibiotic treatment. Preoperative and postoperative spine sagittal alignment, visual analog scale scores, and Kirkaldy-Willis criteria for functional outcomes were evaluated.
An infection clearance rate of 100% was ultimately achieved for the patients who underwent TLIDF with short posterior instrumentation. TLIDF yielded better outcomes than traditional conservative treatment in terms of spine alignment correction, functional outcomes, and quality of life.
Based on previously reported data and the findings of this study, we suggest that surgical intervention should be used in certain cases, as it can achieve better outcomes than conservative treatment. We recommend a novel single posterior approach with TLIDF and posterior pedicle screw instrumentation for management of postdiscectomy discitis.
传统上，对于大多数术后椎间盘炎患者，推荐采用长期抗生素治疗和卧床休息的非手术治疗作为一线治疗方法。在有限的适应证范围内，最近的治疗趋势是进行手术清创，然后长期使用抗生素。这项描述性研究调查了经椎间孔腰椎椎间融合术（TLIDF）联合静脉使用抗生素治疗椎间盘切除术后椎间盘炎是否合适。
本研究回顾性分析了10例接受手术TLIDF并随后接受抗生素治疗的术后椎间盘炎患者的人口统计学数据、实验室数据、影像学和磁共振成像。评估了术前和术后脊柱矢状位排列、视觉模拟评分以及功能结果的Kirkaldy-Willis标准。
接受短节段后路内固定的TLIDF患者最终实现了100%的感染清除率。在脊柱排列矫正、功能结果和生活质量方面，TLIDF比传统保守治疗产生了更好的结果。
基于先前报道的数据和本研究的结果，我们建议在某些情况下应采用手术干预，因为它可以比保守治疗取得更好的结果。我们推荐一种新颖的单一后路方法，即TLIDF联合后路椎弓根螺钉内固定来治疗椎间盘切除术后椎间盘炎。
