Spiegl Ulrich Josef Albert, Kilper Anica, Glasmacher Stefan, Heyde Christoph-Eckhard, Josten Christoph
Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland.
Klinik für Orthopädie, Unfall- und Handchirurgie, Klinikum Chemnitz, Flemmingstr. 2, 09116, Chemnitz, Deutschland.
Unfallchirurg. 2020 Sep;123(9):724-730. doi: 10.1007/s00113-020-00781-y.
Spondylodiscitis is a rare disease with an increasing incidence.
In this retrospective study 112 patients with spondylodiscitis surgically treated from 1 January 2005 to 31 December 2012 in a level I spine center were investigated with respect to potential prognostic criteria. The time period covered by the investigation was the duration of hospitalization. The parameters analyzed were mortality, age, localization of the spondylodiscitis, detection of abscesses and pathogens, neurological status and body mass index (BMI).
The average age of the patients was 68.3 years (±12.9 years). The mortality rate during hospitalization was 10.7% (N = 12). Older patients had a significantly higher in-hospital mortality rate (p = 0.008). Abscess formation was found in 49.1% of the patients and was associated with a significantly longer hospital stay (p = 0.001) and in the intensive care unit (ICU, p = 0.001) as well as a higher risk of revision surgery (p = 0.018). In addition, obese patients had a significantly higher occurrence of abscesses (p = 0.034). Pathogen detection was successful in 60.7 % of the cases with Staphylococcus aureus as the most frequent pathogen. Detection of pathogens was associated with a longer hospital stay (p = 0.006) and a greater need of intensive care monitoring (p = 0.017). Patients with a nephropathy had a significantly increased mortality, longer duration of hospitalization and a more frequent occurrence of multilevel afflictions.
Old age, abscess formation, positive detection of pathogens and renal failure can be used as prognostic criteria. Risk factors for formation of abscesses include a lumbar localization of spondylodiscitis, nephropathy as well as detection of a pathogen and obesity.
脊椎椎间盘炎是一种发病率呈上升趋势的罕见疾病。
在这项回顾性研究中，对2005年1月1日至2012年12月31日期间在一级脊柱中心接受手术治疗的112例脊椎椎间盘炎患者的潜在预后标准进行了调查。调查涵盖的时间段为住院时间。分析的参数包括死亡率、年龄、脊椎椎间盘炎的部位、脓肿和病原体的检测、神经状态和体重指数（BMI）。
患者的平均年龄为68.3岁（±12.9岁）。住院期间的死亡率为10.7%（N = 12）。老年患者的院内死亡率显著更高（p = 0.008）。49.1%的患者发现有脓肿形成，这与住院时间显著延长（p = 0.001）、入住重症监护病房（ICU，p = 0.001）以及再次手术风险更高（p = 0.018）相关。此外，肥胖患者脓肿的发生率显著更高（p = 0.034）。60.7%的病例成功检测到病原体，其中金黄色葡萄球菌是最常见的病原体。病原体检测与住院时间延长（p = 0.006）和更需要重症监护监测（p = 0.017）相关。患有肾病的患者死亡率显著增加、住院时间延长且多级病变的发生率更高。
老年、脓肿形成、病原体检测呈阳性和肾衰竭可作为预后标准。脓肿形成的危险因素包括脊椎椎间盘炎的腰椎部位、肾病以及病原体检测和肥胖。
