Setoue Tomoyuki, Nakamura Jun-Ichiro, Hara Jun
Saiwai Tsurumi Hospital, 1-21 Toyooka, Tsurumi, Yokohama 230-0062, Japan.
Minim Invasive Surg. 2021 Nov 25;2021:5582849. doi: 10.1155/2021/5582849. eCollection 2021.
Conservative therapy, including appropriate antibiotics and bracing, is usually adequate for most patients with pyogenic spondylodiscitis. If conservative treatment fails, surgical intervention is needed. However, major spinal surgery comprising anterior debridement and accompanying bone grafting with or without additional instrumentation is often related to undesired postoperative complications. In recent years, with minimally invasive surgery, the diagnostic and therapeutic value of endoscopic lavage and drainage has been proven. This study reports a case series of patients who required open revision surgery after treatment with endoscopic surgery using the full endoscopic discectomy system (FED), indicating the surgical limitations of endoscopic surgery for pyogenic spondylodiscitis.
We retrospectively investigated the medical records of 4 patients who underwent open debridement and anterior reconstruction with posterior instrumentation following endoscopic surgery for their advanced lumbar infectious spondylitis. They had been receiving conservative treatment with antibiotics for 12-15 days. They also had various comorbidities, including kidney disease, heart failure, and diabetes. Numerical rating scale pain response, perioperative imaging studies, and C-reactive protein (CRP) levels were determined, and causative bacteria were identified. Primarily, the bone destruction stage was classified using computed tomography with reference to Griffiths' scheme.
All patients had severe back pain before surgery with no relief of the pain after FED. Increased pain, including radicular pain after FED, was noted in one case. Causative pathogens from biopsy specimens were identified in 3 (75%) of the 4 cases. In preoperative radiological evaluation, all cases were classified as destructive stage in Griffiths' scheme. The CRP levels of all the patients decreased slightly after endoscopic surgery. Relapse of spinal infection after revision surgery was not noted in any patient during the follow-up period.
The surgical treatment of destructive-stage spondylitis with FED alone can increase low back pain due to aggressive debridement.
保守治疗，包括使用适当的抗生素和支具，通常对大多数化脓性脊椎间盘炎患者足够。如果保守治疗失败，则需要手术干预。然而，包括前路清创术以及伴有或不伴有额外内固定的植骨术在内的大型脊柱手术常伴有不良术后并发症。近年来，随着微创手术的发展，内镜灌洗和引流的诊断和治疗价值已得到证实。本研究报告了一系列在内镜手术中使用全内镜椎间盘切除术系统（FED）治疗后需要进行开放翻修手术的患者病例，表明内镜手术治疗化脓性脊椎间盘炎存在手术局限性。
我们回顾性研究了4例因晚期腰椎感染性脊柱炎在内镜手术后接受开放清创术及前路重建并后路内固定的患者的病历。他们接受了12 - 15天的抗生素保守治疗。他们还患有各种合并症，包括肾病、心力衰竭和糖尿病。确定了数字评分量表疼痛反应、围手术期影像学检查以及C反应蛋白（CRP）水平，并鉴定了致病细菌。主要参照格里菲斯方案，使用计算机断层扫描对骨破坏阶段进行分类。
所有患者术前均有严重背痛，FED术后疼痛无缓解情况。1例患者术后出现疼痛加重，包括FED术后的根性疼痛。4例中有3例（75%）从活检标本中鉴定出致病病原体。在术前放射学评估中，所有病例根据格里菲斯方案均被分类为破坏期。所有患者的CRP水平在内镜手术后略有下降。随访期间，所有患者在翻修手术后均未出现脊柱感染复发。
仅用FED治疗破坏期脊柱炎会因积极清创导致腰痛加重。
