Kamal Abdullah Mohammed, El-Sharkawi Mohammad M, El-Sabrout Moataz, Hassan Mohammad Gamal
Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University, Assiut 71511, Egypt.
SICOT J. 2020;6:5. doi: 10.1051/sicotj/2020002. Epub 2020 Feb 14.
The term Spondylodiscitis (SD) involves infection of the vertebra (Spondylitis), infection of the intervertebral disc (Discitis), or both (Spondylodiscitis). SD represents a diagnostic and therapeutic challenge to any spine surgeon. Any delay in its diagnosis or management may cause serious long-term morbidity or even lead to mortality. In this study, we report the experience of our Institution in the management of severe and complicated cases of SD.
Over a period of 1 year, 39 patients with the diagnosis of SD were surgically treated in Assiut University Hospital, Assiut, Egypt. The management processes were tailored according to the clinical condition, radiological and lab studies of each case; and patients were then prospectively followed-up until they were cured (for a minimum of 6 months). The outcomes were analyzed, to be able to give recommendations while aiming to improve the overall outcome of such dangerous health issue.
In this series, patients were managed surgically by drainage and debridement of the infection site with/without instrumented fusion. Results included: satisfactory fusion was achieved in 97.3% of patients (confidence interval [CI] = 0.6856-1.3421). Neurological Improvement Rate (NIR) was 71.5% (Statistically significant improvement P-value = 0.014) and reoperation rate was 5% (CI = 0.00621-0.18525). Mortality rate was 7.7% (CI = 0.016-0.209). Several aspects were analyzed in each case.
Surgical management of severe and complicated cases of SD allows for effective debridement and rapid cure of inflammation, earlier patient mobilization and significantly shorter duration of antibiotic usage.
脊椎椎间盘炎（SD）这一术语涵盖了椎体感染（脊柱炎）、椎间盘感染（椎间盘炎）或两者皆有（脊椎椎间盘炎）。SD对任何脊柱外科医生来说都是一个诊断和治疗上的挑战。其诊断或治疗的任何延迟都可能导致严重的长期发病甚至死亡。在本研究中，我们报告了我们机构处理严重和复杂SD病例的经验。
在1年的时间里，埃及阿斯尤特大学医院对39例诊断为SD的患者进行了手术治疗。根据每个病例的临床状况、放射学和实验室检查结果制定管理流程；然后对患者进行前瞻性随访，直至治愈（至少6个月）。对结果进行分析，以便在旨在改善这一危险健康问题的总体结果的同时给出建议。
在本系列中，患者通过对感染部位进行引流和清创并伴有或不伴有器械融合的方式进行手术治疗。结果包括：97.3%的患者实现了满意的融合（置信区间[CI]=0.6856 - 1.3421）。神经功能改善率（NIR）为71.5%（统计学上有显著改善，P值=0.014），再次手术率为5%（CI=0.00621 - 0.18525）。死亡率为7.7%（CI=0.016 - 0.209）。对每个病例的几个方面进行了分析。
对严重和复杂的SD病例进行手术管理可实现有效的清创和炎症的快速治愈，使患者更早活动，并显著缩短抗生素使用时间。
