Camino-Willhuber Gaston, Beyer Ryan S, Hatter Matthew J, Franklin Austin J, Brown Nolan J, Hashmi Sohaib, Oh Michael, Bhatia Nitin, Lee Yu-Po
1Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Departments of2Orthopaedics and.
J Neurosurg Case Lessons. 2022 Jul 25;4(4):CASE22222. doi: 10.3171/CASE22222.
Pyogenic spinal infections (PSIs) are a group of uncommon but serious infectious diseases that are characterized by inflammation of the endplate-disc unit. PSIs are considered more prevalent and aggressive among patients with chronic immunocompromised states. Association between PSIs and liver disease has not been systematically analyzed. The authors performed a systematic review to study baseline characteristics, clinical presentation, and mortality of patients with PSI in the setting of chronic liver disease.
The authors presented the case of a 72-year-old female patient with chronic liver disease who presented with severe low back pain and bilateral lower weakness. Imaging studies showed T10-11 spondylodiscitis. The patient received decompression and fusion surgery with partial neurological improvement. The authors performed a systematic literature search of spondylodiscitis and liver disease, and eight published articles met the studies inclusion and exclusion criteria. These studies featured a total of 144 patients, of whom 129 met inclusion criteria (mean age, 60.5 years, range 40 to 83 years; 62% males). Lumbar infection was the most common report (67%), with (48%) as the main causative microorganism. Neurological compromise was present in 69% of patients. Surgical intervention occurred in 70.5% of patients, and the average duration of antibiotic treatment was 69.4 days. Postoperative complication rate was 28.5%, with a 30- and 90-day mortality of 17.2% and 24.8%, respectively.
Pyogenic spondylodiscitis in patients with liver disease was associated with a high rate of neurological compromise, postoperative complications, and mortality.
化脓性脊柱感染（PSIs）是一组罕见但严重的感染性疾病，其特征为终板-椎间盘单元炎症。PSIs在慢性免疫功能低下患者中被认为更为常见且具有侵袭性。PSIs与肝病之间的关联尚未得到系统分析。作者进行了一项系统评价，以研究慢性肝病背景下PSIs患者的基线特征、临床表现和死亡率。
作者报告了一例72岁患有慢性肝病的女性患者，该患者出现严重的腰痛和双侧下肢无力。影像学检查显示T10-11椎体椎间盘炎。患者接受了减压融合手术，神经功能部分改善。作者对椎体椎间盘炎和肝病进行了系统的文献检索，8篇已发表文章符合研究纳入和排除标准。这些研究共纳入144例患者，其中129例符合纳入标准（平均年龄60.5岁，范围40至83岁；62%为男性）。腰椎感染是最常见的报告（67%），[具体微生物名称未给出]（48%）为主要致病微生物。69%的患者存在神经功能损害。70.5%的患者接受了手术干预，抗生素治疗的平均持续时间为69.4天。术后并发症发生率为28.5%，30天和90天死亡率分别为17.2%和24.8%。
肝病患者的化脓性椎体椎间盘炎与神经功能损害、术后并发症和死亡率的高发生率相关。
