Cabrera Juan P, Camino-Willhuber Gastón, Muthu Sathish, Guiroy Alfredo, Valacco Marcelo, Pola Enrico
Department of Neurosurgery, Hospital Clínico Regional de Concepción.
Faculty of Medicine, University of Concepción, Concepción, Chile.
Clin Spine Surg. 2023 Feb 1;36(1):24-33. doi: 10.1097/BSD.0000000000001325. Epub 2022 Mar 29.
A systematic review and meta-analysis.
This meta-analysis aimed to compare percutaneous (PPS) versus open pedicle screw (OPS) fixation for treatment of thoracic and lumbar spondylodiscitis.
Pyogenic spondylodiscitis of the thoracic and lumbar spine can produce instability, deformity, and/or neurological compromise. When medical treatment is unsuccessful, surgical treatment is indicated, with the conventional open approach the usual standard of care. However, percutaneous techniques can be advantageous in medically vulnerable patients.
A literature search was performed using the PubMed, Web of Science, and Scopus databases, looking for comparative articles on pyogenic spondylodiscitis requiring surgical stabilization with pedicle screws. This systematic review is reported according to PRISMA guidelines.
From 215 articles initially identified, 7 retrospective studies were analyzed, encapsulating an overall sample of 722 patients: 405 male (56.1%) and 317 female (43.9%). The treatment modality was PPS fixation in 342 patients (47.4%) and OPS fixation in 380 (52.6%). For PPS, operating time was 29.75 minutes ( P <0.0001), blood loss 390.18 mL ( P <0.00001), postoperative pain 1.54 points ( P <0.00001), and length of stay 4.49 days ( P =0.001) less than with OPS fixation, and wound infection 7.2% ( P =0.003) less frequent. No difference in screw misplacement ( P =0.94) or loosening ( P =0.33) rates was observed.
Employing PPS fixation to treat pyogenic spondylodiscitis of the thoracic and lumbar spine is associated with significantly reduced operating time, blood loss, postoperative pain, length of stay, and rates of wound infection than OPS fixation, with no difference between the 2 treatments in rates of screw misplacement or screw loosening.
系统评价与荟萃分析。
本荟萃分析旨在比较经皮椎弓根螺钉固定术（PPS）与开放椎弓根螺钉固定术（OPS）治疗胸腰椎化脓性脊椎炎的效果。
胸腰椎化脓性脊椎炎可导致脊柱不稳定、畸形和/或神经功能损害。当药物治疗无效时，需进行手术治疗，传统的开放手术是常用的标准治疗方法。然而，经皮技术对身体状况较差的患者可能更具优势。
通过PubMed、Web of Science和Scopus数据库进行文献检索，查找关于需要用椎弓根螺钉进行手术稳定治疗的化脓性脊椎炎的比较性文章。本系统评价按照PRISMA指南报告。
从最初检索到的215篇文章中，分析了7项回顾性研究，共纳入722例患者：男性405例（56.1%），女性317例（43.9%）。治疗方式为PPS固定342例（47.4%），OPS固定380例（52.6%）。与OPS固定相比，PPS固定的手术时间缩短29.75分钟（P<0.0001），失血量减少390.18毫升（P<0.00001），术后疼痛减轻1.54分（P<0.00001），住院时间缩短4.49天（P=0.001），伤口感染发生率降低7.2%（P=0.003）。螺钉误置率（P=0.94）和松动率（P=0.33）在两种治疗方式之间无差异。
与OPS固定相比，采用PPS固定治疗胸腰椎化脓性脊椎炎可显著缩短手术时间、减少失血量、减轻术后疼痛、缩短住院时间并降低伤口感染发生率，两种治疗方式在螺钉误置率或螺钉松动率方面无差异。
