Purea Tangi, Vettivel Jeevan, Hunt Lyn, Passias Peter G, Baker Joseph F
3718Waikato Hospital, Hamilton, New Zealand.
22457Monash University, Clayton, Victoria, Australia.
Global Spine J. 2021 Jul;11(6):881-888. doi: 10.1177/2192568220928965. Epub 2020 Jun 9.
Single center retrospective cohort study.
Assess the association between well-known radiographic features for spinal instability from the Spinal Instability in Neoplasia Score (SINS) and surgical invasiveness in treating vertebral column osteomyelitis (VCO). This will potentially help surgeons in surgical planning and aid in developing a pathology specific score.
Patients with VCO were identified from hospital coding. On preoperative computed tomography radiographic features, including spinal alignment, vertebral body collapse, location, type of bone lesion, and posterolateral involvement were assessed and scored 0 (stable) to 15 (highly unstable). Surgical invasiveness was graded as 0 = no surgery, 1 = decompression alone, 2 = shortening or posterior stabilization, or 3 = anterior column reconstruction.
A total of 41 patients were included. The mean age of the cohort was 63.3 years (SD 12.0) with male comprising 78%. The mean total radiographic score for the nonsurgical group was 6.39 (3.14) and for the surgical group 10.38 (3.06), < .001. Spinal alignment, vertebral body collapse, type of bone lesion, and posterolateral involvement correlated with surgical invasiveness (all s < .05). Subgroup comparison following analysis of variance showed that only spinal alignment was significantly different between groups 2 and 3.
Our findings show correlation of the radiographic components of the SINS with surgical invasiveness in management of pyogenic VCO-these findings should aid development of an "instability score" in pyogenic VCO. While most radiographic features assessed correlated with surgical invasiveness spinal alignment appears to be the key feature in determining the need for more invasive surgery.
单中心回顾性队列研究。
评估肿瘤性脊柱不稳评分（SINS）中脊柱不稳的知名影像学特征与治疗脊柱骨髓炎（VCO）手术侵袭性之间的关联。这可能有助于外科医生进行手术规划，并有助于制定针对病理的评分。
通过医院编码识别VCO患者。对术前计算机断层扫描的影像学特征进行评估，包括脊柱排列、椎体塌陷、位置、骨病变类型和后外侧受累情况，并评分为0（稳定）至15（高度不稳定）。手术侵袭性分为0 = 未手术，1 = 单纯减压，2 = 缩短或后路稳定，或3 = 前路重建。
共纳入41例患者。队列的平均年龄为63.3岁（标准差12.0），男性占78%。非手术组的平均总影像学评分为6.39（3.14），手术组为10.38（3.06），P <.001。脊柱排列、椎体塌陷、骨病变类型和后外侧受累与手术侵袭性相关（所有P <.05）。方差分析后的亚组比较显示，仅脊柱排列在2组和3组之间有显著差异。
我们的研究结果表明，SINS的影像学成分与化脓性VCO治疗中的手术侵袭性相关——这些结果应有助于制定化脓性VCO的“不稳评分”。虽然评估的大多数影像学特征与手术侵袭性相关，但脊柱排列似乎是决定是否需要更具侵袭性手术的关键特征。
