Burkhard Marco D, Hassanzadeh Ali, Andronic Octavian, Götschi Tobias, Uçkay Ilker, Farshad Mazda
University Spine Center, Department of Orthopedic Surgery.
Unit for Clinical and Applied Research.
N Am Spine Soc J. 2022 Sep 21;12:100172. doi: 10.1016/j.xnsj.2022.100172. eCollection 2022 Dec.
Occult infections in spinal pseudarthrosis revisions have been reported in the literature, but the relevance of such an infection on patient outcomes is unknown. We aimed to elucidate clinical outcomes and re-revision risks between patients with and without occult infections in spinal revision surgery for pseudarthrosis.
In this matched case-control study, we identified 128 patients who underwent thoracolumbar revision surgery from 2014-2019 for pseudarthrosis of the spine. Among them, 13 (10.2%) revealed an occult infection (defined by at least two positive intraoperative tissue samples with the same pathogen), and nine of these 13 were available for follow-up. We selected 18 of the 115 controls using a 2:1 fuzzy matching based on fusion length and length of follow-up. The patients were followed up to assess subsequent re-revision surgeries and the following postoperative patient-reported outcome measures (PROMs): overall satisfaction, Oswestry Disability Index, 5-level EQ-5D, and Short Form 36.
Patient characteristics, surgical data, and length of follow-up were equal between both study groups. The rate of re-revision free survival after the initial pseudarthrosis revision surgery was higher in the occult infection group (77.8%) than the non-infectious controls (44.4%), although not significantly (0.22). The total number of re-revision surgeries, including re-re-revisions, was thirteen (in ten patients) in the control and two (in two patients) in the occult infection group (p = 0.08) after a median follow-up of 24 months (range 13-75). Four cases in the control group underwent re-revision for pseudarthrosis compared to none in the infected group. Satisfactory scores were recorded in all PROMs, with similar scores between the two groups.
The presence of an occult infection accompanying spinal pseudarthrosis revision was not inferior to non-infected pseudarthrosis revisions in a matched, small sample size cohort study. This may be explained due to the possibility of targeted treatment of the identified cause of pseudarthrosis.
脊柱假关节翻修术中隐匿性感染在文献中已有报道，但这种感染对患者预后的相关性尚不清楚。我们旨在阐明脊柱假关节翻修手术中有无隐匿性感染患者的临床结局和再次翻修风险。
在这项匹配病例对照研究中，我们确定了2014年至2019年因脊柱假关节而行胸腰椎翻修手术的128例患者。其中，13例（10.2%）显示存在隐匿性感染（定义为至少两份术中组织样本同一病原体检测呈阳性），这13例中的9例可供随访。我们根据融合长度和随访时间，采用2:1模糊匹配从115例对照中选择了18例。对患者进行随访，以评估后续的再次翻修手术以及术后患者报告的以下结局指标（PROMs）：总体满意度、Oswestry功能障碍指数、5级EQ-5D和简明健康调查问卷36项。
两个研究组的患者特征、手术数据和随访时间均相等。隐匿性感染组初次假关节翻修手术后无再次翻修生存的比例（77.8%）高于非感染对照组（44.4%），尽管差异无统计学意义（P=0.22）。在中位随访24个月（范围13-75个月）后，对照组包括再次再次翻修在内的再次翻修手术总数为13例（10例患者），隐匿性感染组为2例（2例患者）（P=0.08）。对照组有4例因假关节而行再次翻修，而感染组无。所有PROMs均记录到满意的评分，两组评分相似。
在一项匹配的小样本队列研究中，脊柱假关节翻修术中伴随的隐匿性感染并不比未感染的假关节翻修差。这可能是由于对已确定的假关节病因进行靶向治疗的可能性。
