Centrum Für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Salzburg - Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
Eur Spine J. 2022 May;31(5):1099-1106. doi: 10.1007/s00586-022-07157-3. Epub 2022 Mar 7.
Even though spinal infections are associated with high mortality and morbidity, their therapy remains challenging due to a lack of established classification systems and widely accepted guidelines for surgical treatment. This study's aim therefore was to propose a comprehensive classification system for spinal instability based on the Spinal Instability Neoplastic Score (SINS) aiding spine surgeons in choosing optimal treatment for spontaneous spondylodiscitis.
Patients who were treated for spontaneous spondylodiscitis and received computed tomography (CT) imaging were included retrospectively. The Spinal Instability Spondylodiscitis Score (SISS) was developed by expert consensus. SINS and SISS were scored in CT-images by four readers. Intraclass correlation coefficients (ICCs) and Fleiss' Kappa were calculated to determine interrater reliabilities. Predictive validity was analyzed by cross-tabulation analysis.
A total of 127 patients were included, 94 (74.0%) of which were treated surgically. Mean SINS was 8.3 ± 3.2, mean SISS 8.1 ± 2.4. ICCs were 0.961 (95%-CI: 0.949-0.971) for total SINS and 0.960 (95%-CI: 0.946-0.970) for total SISS. SINS yielded false positive and negative rates of 12.5% and 67.6%, SISS of 15.2% and 40.0%, respectively.
We show high reliability and validity of the newly developed SISS in detecting unstable spinal lesions in spontaneous spondylodiscitis. Therefore, we recommend its use in evaluating treatment choices based on spinal biomechanics. It is, however, important to note that stability is merely one of multiple components in making surgical treatment decisions.
尽管脊柱感染与高死亡率和发病率相关，但由于缺乏既定的分类系统和广泛接受的手术治疗指南，其治疗仍然具有挑战性。因此，本研究旨在提出一种基于脊柱不稳定肿瘤评分（SINS）的综合脊柱不稳定分类系统，以帮助脊柱外科医生为自发性脊椎炎选择最佳治疗方法。
回顾性纳入接受计算机断层扫描（CT）成像治疗的自发性脊椎炎患者。通过专家共识制定了脊柱不稳定脊椎炎评分（SISS）。由四位读者对 CT 图像中的 SINS 和 SISS 进行评分。计算组内相关系数（ICC）和 Fleiss' Kappa 以确定评分者间的可靠性。通过交叉表分析来分析预测有效性。
共纳入 127 例患者，其中 94 例（74.0%）接受了手术治疗。SINS 平均为 8.3±3.2，SISS 平均为 8.1±2.4。总 SINS 的 ICC 为 0.961（95%CI：0.949-0.971），总 SISS 的 ICC 为 0.960（95%CI：0.946-0.970）。SINS 的假阳性和假阴性率分别为 12.5%和 67.6%，SISS 的假阳性和假阴性率分别为 15.2%和 40.0%。
我们证明了新开发的 SISS 在检测自发性脊椎炎不稳定脊柱病变方面具有较高的可靠性和有效性。因此，我们建议在基于脊柱生物力学评估治疗选择时使用它。然而，需要注意的是，稳定性仅是做出手术治疗决策的多个因素之一。
