Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
World Neurosurg. 2022 Nov;167:e795-e805. doi: 10.1016/j.wneu.2022.08.095. Epub 2022 Aug 28.
Recently, the incidence of pyogenic vertebral osteomyelitis with spinal epidural abscess (SEA) has increased. However, the most appropriate surgical management remains debatable, especially for older patients. This study aimed to compare the clinical course in older patients aged between 65 and 79 years and those 80 years or older undergoing surgery for SEA.
Data on patient demographics, surgical characteristics, complications, hospital clinical course, and 90-day mortality of patients diagnosed with pyogenic vertebral osteomyelitis and SEA between September 2005 and December 2021 were collected. Comorbidities were assessed using the age-adjusted Charlson comorbidity index.
We enrolled 45 patients aged 65-79 years and 32 patients ≥80 years. Patients ≥80 years had significantly higher rates of Charlson comorbidity index (9.2 ± 2.4) than younger patients (6.5 ± 2.5; P < 0.001). Arterial hypertension, renal failure, and dementia were significantly more prevalent in octogenarians (P < 0.05). Patients aged ≥80 years had a significantly longer length of hospitalization, while the intensive care unit stay was similar between groups. In-hospital mortality was significantly greater in those ≥80 years (n = 3, 9.4% vs. n = 0, 0.0%; P = 0.029), whereas no differences in 90-day mortality or 30-day readmission were observed. In the second-stage analysis, significant improvements in blood infection parameters and neurologic status were detected in both groups. Of adverse events, pneumonia occurred significantly more frequently in patients aged ≥80 years.
Surgical management leads to significant improvements in both laboratory and clinical parameters in older patients. Nevertheless, a personalized medical approach is mandatory in frail patients, especially octogenarians. A clear discussion regarding the potential risk is unambiguously recommended.
近年来，化脓性脊柱骨髓炎伴硬脊膜外脓肿（SEA）的发病率有所增加。然而，对于老年患者，最合适的手术治疗方法仍存在争议。本研究旨在比较年龄在 65 至 79 岁之间的老年患者和 80 岁或以上接受 SEA 手术的患者的临床病程。
收集了 2005 年 9 月至 2021 年 12 月期间诊断为化脓性脊柱骨髓炎伴 SEA 的患者的人口统计学、手术特征、并发症、住院临床病程和 90 天死亡率的数据。使用年龄调整后的 Charlson 合并症指数评估合并症。
我们纳入了 45 名年龄在 65-79 岁之间的患者和 32 名年龄≥80 岁的患者。≥80 岁的患者 Charlson 合并症指数（9.2±2.4）明显高于年轻患者（6.5±2.5；P＜0.001）。≥80 岁的患者中，动脉高血压、肾衰竭和痴呆更为常见（P＜0.05）。≥80 岁的患者住院时间明显更长，而两组的重症监护病房停留时间相似。≥80 岁的患者住院死亡率明显更高（n=3，9.4%vs.n=0，0.0%；P=0.029），但 90 天死亡率或 30 天再入院率无差异。在第二阶段分析中，两组的血液感染参数和神经状态均显著改善。在不良事件中，≥80 岁的患者中肺炎的发生率明显更高。
手术治疗可显著改善老年患者的实验室和临床参数。然而，对于虚弱的患者，特别是 80 岁以上的患者，需要采取个性化的医疗方法。明确讨论潜在风险是明确推荐的。
