Banse X, Kaminski L, Irda N, Briquet C, Cornu O, Yombi J-C
Department of Orthopaedic and Trauma Surgery, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
Pharmacy Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
Brain Spine. 2022 Sep 17;2:101186. doi: 10.1016/j.bas.2022.101186. eCollection 2022.
This paper explains how antibiotic loaded cement can be used in surgical treatment of spondylodiscitis to reconstruct the anterior column of the spine.
35 consecutive surgical procedures performed for spondylodiscitis were collected over a 11-year period and charts were reviewed. Most infections were caused mainly by . Most patients had long standing but unsuccessful antibiotic therapy (median 42 days). Other indications included instability, neurologic deficit, abscess, and patients were generally in very poor medical condition.
Anterior debridement was followed by a partial cavity filling with surgical high viscosity PMMA cement in all cases. Cement was a high viscosity gentamycin loaded cement, that was placed in the cavity created by debridement under the direct eye control. In 25 cases, a part of the cavity was filled with freeze dried cancellous bone allograft rehydrated in rifampicin. Spine was further stabilized with an anterior plate in 15 cases, with short (+1/+1) posterior instrumentation in 5 cases, and a long (≥ +2/+2) posterior instrumentation in 11 cases. In four patients, spine was left un-instrumented. Immediate, unrestricted mobilization was always authorized after surgery. None of the patients were reoperated neither for mechanical failure nor for infection relapse.
This report supports the idea that surgical bone cement is an efficient gap filler when used through anterior approach. For small as well as for large defects, it can help to reconstruct the anterior column and locally control the infection in combination with additional stabilization and optimal intravenous and oral antibiotic treatment.
本文阐述了载抗生素骨水泥在脊椎椎间盘炎手术治疗中如何用于重建脊柱前柱。
在11年期间收集了35例连续进行的脊椎椎间盘炎手术病例，并对病历进行了回顾。大多数感染主要由……引起。大多数患者长期接受抗生素治疗但效果不佳（中位数为42天）。其他指征包括不稳定、神经功能缺损、脓肿，且患者一般身体状况很差。
所有病例均在前方清创后用外科高粘度聚甲基丙烯酸甲酯（PMMA）骨水泥进行部分腔隙填充。骨水泥为高粘度庆大霉素载药骨水泥，在直视下置于清创所形成的腔隙内。25例中，部分腔隙用在利福平中复水的冻干松质骨同种异体骨填充。15例用前路钢板进一步稳定脊柱，5例用短节段（+1/+1）后路内固定，11例用长节段（≥+2/+2）后路内固定。4例患者未进行内固定。术后均立即允许无限制活动。无一例患者因机械故障或感染复发而再次手术。
本报告支持以下观点，即通过前路使用外科骨水泥是一种有效的间隙填充物。对于小缺损和大缺损，它可结合额外的稳定措施以及最佳的静脉和口服抗生素治疗，帮助重建前柱并局部控制感染。
