Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea; Department of Orthopedics, The First Affiliated Hospital of Xiamen University, Xiamen, China.
Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
World Neurosurg. 2019 Jul;127:e202-e211. doi: 10.1016/j.wneu.2019.02.206. Epub 2019 Mar 14.
To evaluate the efficacy and clinical results of full endoscopic debridement and drainage (FEDD) for high-risk patients with spondylodiscitis.
Fourteen patients who underwent FEDD at our institution between November 2015 and September 2017 were retrospectively reviewed. All patients had single-level infectious spondylodiscitis and were high-risk candidates for surgery. Their general condition was evaluated according to the American Society of Anesthesiologists grading system. The Charlson Comorbidity Index was used for comprehensive assessment of comorbidity status. Outcomes were evaluated by numeric rating scale (NRS) pain score, Oswestry Disability Index, modified Macnab criteria, and radiographic images at follow-up.
All 14 patients experienced immediate relief of back pain after FEDD, with no procedure-related complications. The causative bacteria were identified in 10 of the 14 patients (71.5%). Half of the 14 patients had an American Society of Anesthesiologists score of ≥3. The average Charlson Comorbidity Index was 5.1 ± 1.6 points. Compared with the preoperative NRS score of 8.2 ± 0.9, the NRS scores at 1 week and 12 months after surgery were 3.4 ± 1.1 and 1.4 ± 1.2, respectively. A significant improvement in Oswestry Disability Index was observed after surgery (preoperative, 30.1 ± 3.9; 12 months postoperatively, 17.6 ± 6.2; P < 0.05). Satisfaction rate was 85.7% based on the Macnab criteria (excellent or good outcome). None of the patients developed any significant kyphotic deformity after FEDD.
FEDD may be an effective alternative to extensive open surgery in patients with infectious spondylodiscitis, especially those who are high-risk candidates for surgery (elderly patients with multiple comorbidities and patients in poor general condition).
评估全内镜清创引流（FEDD）治疗高危脊柱感染性椎间盘炎的疗效和临床结果。
回顾性分析 2015 年 11 月至 2017 年 9 月在我院接受 FEDD 的 14 例患者。所有患者均为单节段感染性椎间盘炎，且为手术高危候选者。根据美国麻醉医师协会（ASA）分级系统评估患者一般状况。采用 Charlson 合并症指数全面评估合并症状态。采用数字疼痛评分（NRS）、Oswestry 残疾指数（ODI）、改良 Macnab 标准以及随访时的影像学图像评估结局。
所有 14 例患者在 FEDD 后均立即缓解背痛，无手术相关并发症。14 例患者中 10 例（71.5%）确定了病原菌。14 例患者中有一半的 ASA 评分为≥3。Charlson 合并症指数平均为 5.1±1.6 分。与术前 NRS 评分 8.2±0.9 相比，术后 1 周和 12 个月的 NRS 评分分别为 3.4±1.1 和 1.4±1.2，差异均有统计学意义（P<0.05）。术后 ODI 显著改善（术前 30.1±3.9；术后 12 个月 17.6±6.2；P<0.05）。根据 Macnab 标准，满意度为 85.7%（优或良）。FEDD 后无患者出现明显的后凸畸形。
对于感染性椎间盘炎患者，尤其是手术高危候选者（患有多种合并症的老年患者和一般状况较差的患者），FEDD 可能是广泛开放性手术的有效替代方法。
