Lindsay Sarah E, Gehling Hanne, Ryu Won Hyung A, Yoo Jung, Philipp Travis
Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA
Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA.
Int J Spine Surg. 2023 Dec 26;17(6):771-778. doi: 10.14444/8541.
Surgical treatment of vertebral osteomyelitis, discitis, and epidural abscesses is indicated in the setting of failure of antibiotic therapy, neurological deficits, epidural abscess, or spinal instability/deformity. Historically, surgical treatment mandated aggressive debridement and spinal stabilization. However, there is growing evidence that direct debridement may not be necessary and may contribute to morbidity. The purpose of this study was to evaluate the efficacy of posterior instrumentation without debridement in treating spinal infections.
A retrospective medical record review was performed to identify patients treated with posterior instrumentation for spontaneous spinal infections. Success of treatment was determined based on postoperative ambulatory status, surgical complications, and need for revision surgery.
Twenty-seven patients treated with posterior-only long-segmented rigid fixation without formal debridement of infected material were included. The most common indications for surgical intervention included spinal instability (67%), neurologic compromise (67%), and failure of prolonged antibiotic treatment (63%). There were no recurrent deep infections in 21 of 22 patients who had long-term follow-up. Four patients required revision surgery, and 3 additional patients requested elective hardware removal. Postoperatively, 70% were ambulatory with no assistive devices postoperatively.
Vertebral osteomyelitis/discitis are challenging medical problems. Single-stage long-segment fusion without formal debridement combined with antibiotics is effective in the management of spontaneous spinal infections.
The present study suggests that acute instrumentation without anterior debridement is associated with a resolution of infection and improvements in neurologic deficits in patient with spontaneous spine infections.
对于抗生素治疗失败、出现神经功能缺损、硬膜外脓肿或脊柱不稳定/畸形的椎体骨髓炎、椎间盘炎和硬膜外脓肿患者，需进行手术治疗。从历史上看，手术治疗要求进行积极的清创和脊柱稳定术。然而，越来越多的证据表明，直接清创可能并非必要，而且可能会增加发病率。本研究的目的是评估不进行清创的后路内固定治疗脊柱感染的疗效。
进行回顾性病历审查，以确定接受后路内固定治疗自发性脊柱感染的患者。根据术后活动状态、手术并发症和翻修手术需求来确定治疗是否成功。
纳入了27例仅接受后路长节段坚强固定且未对感染物质进行正式清创的患者。手术干预的最常见指征包括脊柱不稳定（67%）、神经功能损害（67%）和长期抗生素治疗失败（63%）。在22例接受长期随访的患者中，21例没有复发性深部感染。4例患者需要翻修手术，另外3例患者要求择期取出内固定装置。术后，70%的患者术后无需辅助装置即可行走。
椎体骨髓炎/椎间盘炎是具有挑战性的医学问题。单阶段长节段融合术在不进行正式清创的情况下联合使用抗生素，对于自发性脊柱感染的治疗是有效的。
本研究表明，对于自发性脊柱感染患者，不进行前路清创的急性内固定与感染的消退及神经功能缺损的改善相关。
