Department of Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Faculty of Medicine and University Hospital Cologne Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany.
Arch Orthop Trauma Surg. 2023 May;143(5):2317-2324. doi: 10.1007/s00402-022-04431-3. Epub 2022 Mar 31.
Vertebral osteomyelitis (VO) is a severe clinical entity associated with significant morbidity and mortality. Several studies have showed that successful treatment of VO patients leads to significantly improved quality of life (QoL). Nevertheless, QoL levels of these patients remained below those of the general population. There are rarely studies focusing on predicting factors for favourable QoL after surgically treated VO. The aim of this study was to identify factors influencing positively the QoL of patients undergoing surgery for VO.
We conducted a prospective monocentric study including surgically treated VO patients from 2008 to 2016. Data were collected before (T0) and 1 year (T1) after surgery. Primary outcome was favourable QoL defined as back pain with disability restricting normal life activity with a cutoff value ≥ 12 on Oswestry Disability Index (ODI).
Ethical approval was given by the Faculty of Medicine at the University of Cologne (09-182).
A total of 119 patients surviving 1 year after surgically treated VO were analysed. Favourable QoL was achieved in 35/119 patients. On multivariate analysis, younger age (hazard ratio = HR: 0.95; 95% CI 0.91-0.99; p = 0.022), lower albumin (HR: 0.9; 0.83-0.98; p = 0.019) an ASA score ≤ 2 (HR:4.24; 95%CI 1.42-12.68; p = 0.010), and a lower preoperative leg pain on the VAS (HR: 0.86; 95% CI 0.76-0.97; p = 0.018) were identified as independent risk factors for favourable QoL. Interestingly, the absence of neurological deficits was not predictive for a favourable outcome by means of QoL.
One-third of surgically treated VO patients (29%) in our cohort achieved favourable QoL by means of ODI. Our findings can facilitate an estimation of the prognosis when informing the patient before surgery, and underscore that spine disability questionnaires, such as ODI, measuring QoL, are mandatory to evaluate comprehensively the outcome of this entity.
椎体骨髓炎（VO）是一种严重的临床实体，与显著的发病率和死亡率相关。几项研究表明，成功治疗 VO 患者可显著提高生活质量（QoL）。然而，这些患者的 QoL 水平仍低于一般人群。很少有研究关注手术治疗 VO 后对 QoL 有利的预测因素。本研究的目的是确定影响手术治疗 VO 患者 QoL 的因素。
我们进行了一项前瞻性单中心研究，纳入了 2008 年至 2016 年接受手术治疗的 VO 患者。数据在手术前（T0）和手术后 1 年（T1）收集。主要结局是通过 Oswestry 残疾指数（ODI）≥12 定义的有利 QoL，即腰痛伴残疾限制正常生活活动。
科隆大学医学院（09-182）批准了该研究的伦理。
分析了 119 例手术治疗 VO 后存活 1 年的患者。119 例患者中有 35 例达到有利的 QoL。多变量分析显示，年龄较小（风险比[HR]：0.95；95%置信区间[CI]：0.91-0.99；p=0.022）、白蛋白水平较低（HR：0.9；0.83-0.98；p=0.019）、ASA 评分≤2（HR：4.24；95%CI：1.42-12.68；p=0.010）和术前 VAS 下肢疼痛较低（HR：0.86；95%CI：0.76-0.97；p=0.018）是有利 QoL 的独立危险因素。有趣的是，神经系统缺损的缺失并不能通过 QoL 来预测有利的结果。
我们队列中三分之一（29%）的手术治疗 VO 患者通过 ODI 达到有利的 QoL。我们的发现可以帮助在手术前向患者提供预后评估，并强调测量 QoL 的脊柱残疾问卷，如 ODI，是评估该实体结果的必要手段。
