Department for Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
Department for Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
BMC Musculoskelet Disord. 2021 Jan 14;22(1):78. doi: 10.1186/s12891-020-03928-5.
Due to the unspecific symptoms of spondylodiscitis (SpD), an early radiological examination is necessary. However, controversially discussed is the need for magnetic resonance imaging of the entire spine to exclude multisegmental infections and to determine the required surgical interventions. The aims of this study were to assess the incidence of multilevel non-contiguous pyogenic SpD and compare comorbidities, pain symptoms, and subsequent surgical strategies between unifocal (uSpD) and multifocal (mSpD) SpD.
We retrospectively evaluated the data of patients with confirmed, surgically treated, pyogenic SpD who had received a total spine MRI in a single spine center between 2016 and 2018. MRI findings were classified according to Pola-classification and demographics, duration of clinical symptoms (pain and neurology) and Charlson Comorbidity-Index (CCI) results were compared between uSpD und mSpD groups. Surgical therapy was evaluated in patients with mSpD.
uSpD was detected by MRI in 69 of 79 patients (87%). Of these, mSpD was detected in 10 patients (13%) with 21 infected segments (cervical and/ or thoracic and/ or lumbar region). Age and CCI were similar between uSpD and mSpD and 24 of all SpD regions were clinically unapparent. All patients with uSpD were treated operatively. In seven patients with mSpD, all infected levels of the spine were treated surgically in a one-stage procedure; one patient had a two-stage procedure and one patient had surgery at the lumbar spine, and an additional infected segment of the upper thoracic spine was treated conservatively. One patient died before a planned two-stage procedure was performed.
Due to mSpD being found in approximately 13% of SpD cases, and considering the risk of overlooking an mSpD case, MRI imaging of the total spine is recommended. The detection of multiple infection levels can have an impact on the therapeutic strategy chosen.
由于脊椎炎（SpD）的症状不具有特异性，因此早期进行放射学检查是必要的。然而，对于是否需要对整个脊柱进行磁共振成像（MRI）以排除多节段感染并确定所需的手术干预，目前仍存在争议。本研究的目的是评估多节段非连续性化脓性 SpD 的发生率，并比较单发病灶（uSpD）和多发病灶（mSpD）SpD 的合并症、疼痛症状和后续手术策略。
我们回顾性评估了 2016 年至 2018 年期间在单一脊柱中心接受全脊柱 MRI 检查并接受手术治疗的确诊化脓性 SpD 患者的数据。根据 Pola 分类和人口统计学对 MRI 结果进行分类，并比较 uSpD 和 mSpD 组之间的临床症状（疼痛和神经病学）持续时间和 Charlson 合并症指数（CCI）结果。评估 mSpD 患者的手术治疗。
79 例患者中有 69 例（87%）经 MRI 检测出 uSpD。其中，10 例（13%）患者有 21 个感染节段（颈椎和/或胸椎和/或腰椎）。uSpD 和 mSpD 患者的年龄和 CCI 相似，所有 SpD 部位中有 24 个在临床上无明显症状。所有 uSpD 患者均接受手术治疗。在 7 例 mSpD 患者中，所有受感染的脊柱节段均在一期手术中进行了治疗；1 例患者接受了两期手术，1 例患者接受了腰椎手术，而另外 1 个胸椎的受感染节段则保守治疗。1 例患者在计划进行两期手术之前死亡。
由于 mSpD 在 SpD 病例中约占 13%，并且考虑到可能忽略 mSpD 病例的风险，建议对整个脊柱进行 MRI 成像。多个感染水平的检测可能会影响所选择的治疗策略。
