Department of Physiatry, Hospital for Special Surgery, New York, NY.
Kim Barrett Memorial Library, Hospital for Special Surgery, New York, NY.
Pain Physician. 2021 Mar;24(2):101-116.
Interventional spine procedures, such as discography, epidural steroid injections (ESIs), facet joint procedures, and intradiscal therapies, are commonly used to treat pain and improve function in patients with spine conditions. Although infections are known to occur following these procedures, there is a lack of comprehensive studies on this topic in recent years.
To assess and characterize infections following interventional spine procedures.
Systematic review.
Studies that were published from January 2010 to January 2020 and provided information on infections or infection rates following discography, ESIs, facet joint procedures, and intradiscal therapies were included. PubMed (Medline), EMBASE, and Cochrane Library databases were searched, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Infection data were extracted from included studies, and infection rates were calculated for each procedure type. Case reports and infection-only articles were not included in infection rate calculations.
Seventy-two studies met the eligibility criteria and were included in the systematic review. The overall incidence of infection across all studies was 0.12% (231/200,588). The majority of studies (n = 51) were linked to ESIs. Infections related to ESIs were more common than those related to discography or facet joint procedures (0.13% [219/174,431] vs. 0% [0/269] or 0.04% [9/25,697], respectively). Intradiscal therapies had the highest calculated rate of infections (1.05%; 2/191). Quality assessments of the included studies ranged widely.
There was an abundance of case reports in comparison to other study designs; to minimize skewing of the analysis, case reports and infection-only articles were not included in the infection rate. Studies that reported combined infection data for multiple procedures could not be included. Many cohort studies and case series were of lower quality because of their retrospective nature. Additionally, the true incidence of infections related to these procedures is unknown because the majority of these infections often go unreported, and information on regions of the spine and procedure details are often lacking.
Based on our systematic review, the risk of infections following interventional spine procedures appears to be low overall. More studies focusing on infectious complications with larger sample sizes are needed, particularly for intradiscal therapies, in which the microbiome may be an underlying cause of disc infection. To achieve a true incidence of the risk of infections with these procedures, large prospective registries that collect complication rates are necessary.
介入脊柱手术，如椎间盘造影术、硬膜外类固醇注射（ESI）、关节突关节手术和椎间盘内治疗，常用于治疗脊柱疾病患者的疼痛和改善功能。尽管已知这些手术后会发生感染，但近年来缺乏对此主题的综合研究。
评估和描述介入脊柱手术后的感染情况。
系统评价。
纳入了 2010 年 1 月至 2020 年 1 月发表的、提供椎间盘造影术、ESI、关节突关节手术和椎间盘内治疗后感染或感染率信息的研究。根据系统评价和荟萃分析的首选报告项目，检索 PubMed（Medline）、EMBASE 和 Cochrane 图书馆数据库。从纳入的研究中提取感染数据，并计算每种手术类型的感染率。未将病例报告和仅感染文章纳入感染率计算。
72 项研究符合入选标准，并纳入了系统评价。所有研究的总体感染发生率为 0.12%（231/200588）。大多数研究（n=51）与 ESI 相关。与 ESI 相关的感染比与椎间盘造影术或关节突关节手术相关的感染更常见（0.13%[219/174431]比 0%[0/269]或 0.04%[9/25697]）。椎间盘内治疗的感染率最高（1.05%；2/191）。纳入研究的质量评估差异很大。
与其他研究设计相比，病例报告数量较多；为了减少分析的偏倚，未将病例报告和仅感染文章纳入感染率。无法纳入报告多种手术综合感染数据的研究。由于其回顾性性质，许多队列研究和病例系列研究的质量较低。此外，由于这些感染大多未报告，并且经常缺乏有关脊柱区域和手术细节的信息，因此这些手术相关感染的真实发生率尚不清楚。
根据我们的系统评价，介入脊柱手术后感染的风险总体似乎较低。需要更多关注感染并发症的大型研究，特别是对于椎间盘内治疗，其中微生物组可能是椎间盘感染的潜在原因。为了获得这些手术风险的真实感染率，需要进行大型前瞻性注册，以收集并发症发生率。
