Beyer Ryan S, Franklin Austin J, Hatter Matthew J, Nguyen Andrew, Brown Nolan J, Camino-Willhuber Gaston, Davies Nestor R, Hashmi Sohaib, Oh Michael, Bhatia Nitin, Lee Yu-Po
Departments of1Orthopaedics and.
2Neurosurgery, University of California, Irvine, Irvine, California; and.
J Neurosurg Case Lessons. 2022 Jul 25;4(4):CASE22204. doi: 10.3171/CASE22204.
Primary spinal infections (PSIs) are a group of uncommon but serious infectious diseases that are characterized by inflammation of the endplate-disc unit. Pediatric spinal infection is rare and challenging to diagnose due to vague presenting symptoms. Most cases are conservatively managed with surgery rarely indicated. The authors performed a systematic review to study the baseline characteristics, clinical presentation, and outcomes of pediatric patients with PSIs who underwent surgical treatment.
PSI in pediatric patients might behave differently in terms of epidemiology, clinical presentation, and outcomes when compared with nonpediatric patients. Overall, PSI ultimately managed surgically in pediatric patients is associated with a high rate of localized pain, neurological compromise, and treatment failure when compared with nonsurgically managed pediatric spinal infections.
PSIs managed surgically in the pediatric population were found to be caused by in 74.4% of cases and were associated with higher rates of localized pain, neurological compromise, and treatment failure than nonsurgically managed pediatric spinal infections. Thoracic involvement (71.8%) in the spinal infection was reported most commonly in our review. When omitting the cases involving infection, it was revealed that 50% of the pediatric cases involved infection in the cervical region, suggesting increased severity and disease course of cervical spinal infections in the pediatric population. Surgical treatment is indicated only in cases of severe neurological compromise and treatment failure.
原发性脊柱感染（PSIs）是一组罕见但严重的感染性疾病，其特征是终板-椎间盘单元炎症。小儿脊柱感染罕见，由于症状不明确，诊断具有挑战性。大多数病例采用保守治疗，很少需要手术。作者进行了一项系统评价，以研究接受手术治疗的小儿PSIs患者的基线特征、临床表现和预后。
与非小儿患者相比，小儿患者的PSIs在流行病学、临床表现和预后方面可能表现不同。总体而言，与非手术治疗的小儿脊柱感染相比，最终接受手术治疗的小儿PSIs与局部疼痛、神经功能损害和治疗失败的高发生率相关。
在小儿人群中接受手术治疗的PSIs在74.4%的病例中被发现是由[此处原文缺失相关内容]引起的，并且与非手术治疗的小儿脊柱感染相比，局部疼痛、神经功能损害和治疗失败的发生率更高。在我们的综述中，脊柱感染最常见的是累及胸椎（71.8%）。当排除涉及[此处原文缺失相关内容]感染的病例时，发现50%的小儿病例累及颈椎感染，这表明小儿人群颈椎脊柱感染的严重程度和病程增加。仅在严重神经功能损害和治疗失败的情况下才需要手术治疗。
