Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
Department of Orthopaedic Surgery, Ibaraki Western Medical Center, Chikusei, Ibaraki, Japan.
BMC Musculoskelet Disord. 2024 Jun 10;25(1):458. doi: 10.1186/s12891-024-07565-0.
Minimally invasive posterior fixation surgery for pyogenic spondylitis is known to reduce invasiveness and complication rates; however, the outcomes of concomitant insertion of pedicle screws (PS) into the infected vertebrae via the posterior approach are undetermined. This study aimed to assess the safety and efficacy of PS insertion into infected vertebrae in minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis.
This multicenter retrospective cohort study included 70 patients undergoing minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis across nine institutions. Patients were categorized into insertion and skip groups based on PS insertion into infected vertebrae, and surgical data and postoperative outcomes, particularly unplanned reoperations due to complications, were compared.
The mean age of the 70 patients was 72.8 years. The insertion group (n = 36) had shorter operative times (146 versus 195 min, p = 0.032) and a reduced range of fixation (5.4 versus 6.9 vertebrae, p = 0.0009) compared to the skip group (n = 34). Unplanned reoperations occurred in 24% (n = 17) due to surgical site infections (SSI) or implant failure; the incidence was comparable between the groups. Poor infection control necessitating additional anterior surgery was reported in four patients in the skip group.
PS insertion into infected vertebrae during minimally invasive posterior fixation reduces the operative time and range of fixation without increasing the occurrence of unplanned reoperations due to SSI or implant failure. Judicious PS insertion in patients with minimal bone destruction in thoracolumbar pyogenic spondylitis can minimize surgical invasiveness.
对于化脓性脊柱炎，微创后路固定术可减少创伤和并发症发生率；然而，经后路同时将椎弓根螺钉（pedicle screws，PS）置入感染椎体的疗效尚不确定。本研究旨在评估微创后路固定术治疗胸腰椎化脓性脊柱炎时 PS 置入感染椎体的安全性和有效性。
这是一项多中心回顾性队列研究，共纳入 9 家医院的 70 例接受微创后路固定术治疗的胸腰椎化脓性脊柱炎患者。根据 PS 是否置入感染椎体，将患者分为置入组和跳过组，比较两组的手术数据和术后结果，特别是因并发症而进行的非计划性再手术。
70 例患者的平均年龄为 72.8 岁。与跳过组（n=34）相比，置入组（n=36）的手术时间更短（146 分钟 vs. 195 分钟，p=0.032），固定节段更少（5.4 节 vs. 6.9 节，p=0.0009）。因手术部位感染（surgical site infection，SSI）或植入物失败而进行非计划性再手术的比例为 24%（n=17），两组之间无显著差异。跳过组有 4 例因感染控制不佳需要行额外的前路手术。
在微创后路固定术中，将 PS 置入感染椎体可减少手术时间和固定节段，而不会增加因 SSI 或植入物失败而导致的非计划性再手术。对于胸腰椎化脓性脊柱炎患者，在骨质破坏最小的情况下明智地置入 PS 可最大限度地减少手术创伤。
