Lee Jeong Hwan, Kim Jihye, Kim Tae-Hwan
Spine Center, Department of Orthopedics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Anyang 14068, Korea.
Department of Pediatrics, Division of Infection, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Korea.
J Clin Med. 2021 Nov 22;10(22):5451. doi: 10.3390/jcm10225451.
Older patients with pyogenic vertebral osteomyelitis (PVO) usually have more medical comorbidities compared with younger patients, and present with advanced infections from different causative organisms. To aid surgical decision-making, we compared surgical outcomes of older patients with PVO to those who underwent nonoperative treatment. We identified the risk factors for adverse post-operative outcomes, and analyzed the clinical risks from further spinal instrumentation. This retrospective comparative study included 439 patients aged ≥75 years with PVO. Multivariable analysis was performed to compare treatment outcomes among three groups: 194, 130, and 115 patients in the non-operative, non-instrumented, and instrumented groups, respectively. The risk factors for adverse outcomes after surgical treatment were evaluated using a logistic regression model, and the estimates of the multivariable models were internally validated using bootstrap samples. Recurrence and mortality of these patients were closely associated with neurologic deficits, and increased surgical invasiveness, resulting from additional spinal instrumentation, did not increase the risk of recurrence or mortality. We propose that surgical treatment for these patients should focus on improving neurologic deficits through immediate and sufficient removal of abscesses. Spinal instrumentation can be performed if indicated, within reasonable clinical risk.
与年轻患者相比，老年化脓性脊椎骨髓炎（PVO）患者通常有更多的内科合并症，且感染由不同病原体引起且病情更严重。为辅助手术决策，我们比较了老年PVO患者与接受非手术治疗患者的手术结果。我们确定了术后不良结局的风险因素，并分析了进一步脊柱内固定带来的临床风险。这项回顾性比较研究纳入了439例年龄≥75岁的PVO患者。进行多变量分析以比较三组的治疗结果：非手术组、非内固定组和内固定组分别有194例、130例和115例患者。使用逻辑回归模型评估手术治疗后不良结局的风险因素，并使用自助抽样对内变量模型的估计值进行内部验证。这些患者的复发和死亡率与神经功能缺损密切相关，额外脊柱内固定导致的手术侵袭性增加并未增加复发或死亡风险。我们建议，对这些患者的手术治疗应侧重于通过立即充分清除脓肿来改善神经功能缺损。如有指征，可在合理的临床风险范围内进行脊柱内固定。
