Department of Neurosurgery, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
Department of Anaesthesiology and Intensive Care, Hannover Medical School, Hannover, Germany.
Acta Neurochir (Wien). 2023 Dec;165(12):3601-3612. doi: 10.1007/s00701-023-05748-7. Epub 2023 Aug 17.
Surgical procedures in critically ill patients with spondylodiscitis are challenging and there are several controversies. Here, we present our experience with offering surgical intervention early in critically ill septic patients with spondylodiscitis.
After we introduced a new treatment paradigm offering early but limited surgery, eight patients with spondylodiscitis complicated by severe sepsis and multiple organ failure underwent urgent surgical treatment over a 10-year period. Outcome was assessed according to the Barthel index at 12-month follow-up and at the last available follow-up (mean 89 months).
There were 7 men and 1 woman, with a mean age of 62 years. The preoperative ASA score was 5 in 2 patients, and 4 in 6 patients. Six of them presented with high-grade paresis, and in all of them, spondylodiscitis with intraspinal and/or paravertebral abscesses was evident in MR imaging studies. All patients underwent early surgery (within 24 h after admission). The median time in intensive care was 21 days. Out of the eight patients, seven survived. One year after surgery, five patients had a good outcome (Barthel index: 100 (1); 80 (3); and 70 (1)). At the last follow-up (mean 89 months), 4 patients had a good functional outcome (Barthel index between 60 and 80).
Early surgical treatment in critically ill patients with spondylodiscitis and sepsis may result in rapid control of infection and can provide favorable long-term outcome. A general strategy of performing only limited surgery is a valid option in such patients who have a relatively high risk for surgery.
在患有脊椎骨髓炎的重症患者中进行手术极具挑战性，并且存在许多争议。在这里，我们介绍了在患有脊椎骨髓炎合并严重败血症和多器官衰竭的重症患者中早期提供手术干预的经验。
在引入新的治疗模式提供早期但有限的手术治疗后，在 10 年期间，8 例因严重败血症和多器官衰竭而并发脊椎骨髓炎的患者接受了紧急手术治疗。根据 12 个月和最后一次随访（平均 89 个月）的巴氏指数评估预后。
共有 7 名男性和 1 名女性，平均年龄为 62 岁。术前 ASA 评分为 5 分的患者有 2 例，4 分的患者有 6 例。其中 6 例表现为高级别瘫痪，所有患者的磁共振成像研究均显示脊椎骨髓炎伴椎管内和/或椎旁脓肿。所有患者均早期手术（入院后 24 小时内）。重症监护室中位数时间为 21 天。8 例患者中，7 例存活。手术后 1 年，5 例患者预后良好（巴氏指数：100（1）；80（3）和 70（1））。最后一次随访（平均 89 个月）时，4 例患者功能预后良好（巴氏指数 60-80 分）。
在患有脊椎骨髓炎和败血症的重症患者中早期手术治疗可迅速控制感染，并可提供良好的长期预后。对于手术风险相对较高的此类患者，仅行有限手术的一般策略是一种有效的选择。
