Ahsan Kamrul, Hasan Sariful, Khan Shahidul Islam, Zaman Naznin, Almasri Saif Salman, Ahmed Nazmin, Chaurasia Bipin
Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
Department of Anesthesiology, Sarkari Karmachari Hospital, Dhaka, Bangladesh.
J Craniovertebr Junction Spine. 2020 Jul-Sep;11(3):198-209. doi: 10.4103/jcvjs.JCVJS_111_20. Epub 2020 Aug 14.
Treatment option of postoperative discitis (POD) is either conservative or operative, but till date, there are no established validated protocols of the treatment of postoperative lumbar discitis.
The aim of this study was to assess the outcome of conservative versus operative management of POD following single-level lumbar discectomy.
We prospectively studied a total of 38 cases of POD. The patients were diagnosed clinically, radiologically, and by laboratory investigations and followed up with serial erythrocyte sedimentation rate (ESR), C-reactive protein, X-ray, computed tomography (CT), and magnetic resonance imaging. Demographic data, clinical variables, length of hospital stay, duration of antibiotic treatment, and posttreatment complications were collected, and pre- and postoperative assessment was done using the Visual Analog Scale (VAS) and Japanese Orthopaedic Association (JOA) score. Functional outcome of the study was measured by the modified criteria of Kirkaldy-Willis.
VAS score for pain was significantly decreased in both groups after treatment. However, posttreatment differences were not statistically significant. In posttreatment mean JOA score, differences were not statistically significant in both groups except the mean difference (-0.47) of restriction of daily activities, which was statistically significant (95% confidence interval: -0.88--0.07, = 0.025, unpaired -test). About 73.7% and 84.2% of the patients had a satisfactory functional outcome in conservative and operative management groups, respectively, at the end of 12-month follow-up.
Operative management yielded better outcomes than traditional conservative treatment in terms of functional outcomes, length of hospital stays, and duration of antibiotic treatment as determined by both the pain and daily activity levels.
术后椎间盘炎（POD）的治疗选择包括保守治疗或手术治疗，但迄今为止，尚无已确立的、经过验证的术后腰椎间盘炎治疗方案。
本研究的目的是评估单节段腰椎间盘切除术后POD的保守治疗与手术治疗的效果。
我们前瞻性地研究了总共38例POD患者。通过临床、影像学和实验室检查对患者进行诊断，并通过连续的红细胞沉降率（ESR）、C反应蛋白、X线、计算机断层扫描（CT）和磁共振成像进行随访。收集人口统计学数据、临床变量、住院时间、抗生素治疗持续时间和治疗后并发症，并使用视觉模拟量表（VAS）和日本骨科协会（JOA）评分进行术前和术后评估。本研究的功能结局采用Kirkaldy-Willis改良标准进行测量。
两组治疗后疼痛的VAS评分均显著降低。然而，治疗后的差异无统计学意义。在治疗后的平均JOA评分中，除日常活动受限的平均差异（-0.47）有统计学意义外（95%置信区间：-0.88--0.07，P = 0.025，非配对t检验），两组的差异均无统计学意义。在12个月随访结束时，保守治疗组和手术治疗组分别约有73.7%和84.2%的患者功能结局满意。
根据疼痛和日常活动水平确定，手术治疗在功能结局、住院时间和抗生素治疗持续时间方面比传统保守治疗产生更好的效果。
