Department of Rheumatology, CHU Nantes, Nantes, France.
Department of Rheumatology, CHU Rennes, Rennes, France; Department of Rheumatology, GHT Rance-Emeraude, CH Dinan/Saint-Malo, France.
Joint Bone Spine. 2022 Jul;89(4):105333. doi: 10.1016/j.jbspin.2021.105333. Epub 2021 Dec 22.
The aim of our study was to describe spine immobilization in a multicentric cohort of vertebral osteomyelitis (VO), and evaluate its association with neurological complications during follow-up.
We prospectively included patients from 2016 to 2019 in 11 centers. Immobilization, imaging, and neurological findings were specifically analyzed during a 6-month follow-up period.
250 patients were included, mostly men (67.2%, n=168). Mean age was 66.7±15 years. Diagnosis delay was 25 days. The lumbo-sacral spine was most frequently involved (56.4%). At diagnosis, 25.6% patients (n=64) had minor neurological signs and 9.2% (n=23) had major ones. Rigid bracing was prescribed for 63.5% (n=162) of patients, for a median of 6 weeks, with variability between centers (P<0.001). The presence of epidural inflammation and abscess on imaging was associated with higher rates of rigid bracing prescription (OR 2.33, P=0.01). Frailness and endocarditis were negatively associated with rigid bracing prescription (OR 0.65, P<0.01, and OR 0.42, P<0.05, respectively). During follow up, new minor or major neurological complications occurred in respectively 9.2% (n=23) and 6.8% (n=17) of patients, with similar distribution between immobilized and non-immobilized patients.
Spine immobilization prescription during VO remains heterogeneous and seems associated inflammatory lesions on imaging but negatively associated with frailness and presence of endocarditis. Neurological complications can occur despite rigid bracing. Our data suggest that in absence of any factor associated with neurological complication spine bracing might not be systematically indicated. We suggest that spine immobilization should be discussed for each patient after carefully evaluating their clinical signs and imaging findings.
本研究旨在描述多中心椎体骨髓炎（VO）患者的脊柱固定情况，并评估其在随访期间与神经并发症的关系。
我们前瞻性地纳入了 2016 年至 2019 年来自 11 个中心的患者。在 6 个月的随访期间，专门分析了固定、影像学和神经学发现。
共纳入 250 例患者，其中大多数为男性（67.2%，n=168）。平均年龄为 66.7±15 岁。诊断延迟 25 天。腰骶脊柱最常受累（56.4%）。在诊断时，25.6%的患者（n=64）有轻微的神经体征，9.2%（n=23）有严重的神经体征。63.5%（n=162）的患者被开具了硬性支具，中位数为 6 周，各中心之间存在差异（P<0.001）。影像学上存在硬膜外炎症和脓肿与更高的硬性支具处方率相关（OR 2.33，P=0.01）。虚弱和心内膜炎与硬性支具处方呈负相关（OR 0.65，P<0.01 和 OR 0.42，P<0.05）。在随访期间，分别有 9.2%（n=23）和 6.8%（n=17）的患者出现新的轻微或严重的神经并发症，固定和非固定患者之间的分布相似。
VO 期间脊柱固定的处方仍然存在异质性，似乎与影像学上的炎症病变相关，但与虚弱和心内膜炎呈负相关。尽管进行了硬性支具固定，仍可能发生神经并发症。我们的数据表明，在没有任何与神经并发症相关的因素的情况下，脊柱支具可能不是系统地需要的。我们建议，在仔细评估患者的临床体征和影像学发现后，应针对每位患者讨论脊柱固定的问题。
