Papavasiliou K, Panagiotidou S, Kakoulidis P, Domashenko P, Kenanidis E, Bintoudi Α, Arvaniti K, Potoupnis M, Sarris I, Tsiridis E
3 Academic Orthopedic Department, Aristotle University School of Medicine, Thessaloniki, Greece.
Department of Radiology, Papageorgiou General Hospital, Thessaloniki, Greece.
Hippokratia. 2023 Jul-Sep;27(3):106-111.
Spontaneous non-specific pyogenic spondylodiscitis (SNPS) is a rare medical condition, whose optimal treatment remains controversial. We evaluated the multidisciplinary protocol implemented at our department for the conservative treatment of patients with SNPS.
Patients with lumbar or thoracic SNPS, whose treatment was initiated conservatively and had at least six months of follow-up, were enrolled in this retrospective audit study. Patients with specific, postoperative, or iatrogenic spondylodiscitis or necessitating immediate operative treatment were excluded. The location of the infection, initial symptoms, co-morbidities, pathogens, duration of antibiotic treatment, hospitalization and follow-up, and outcome were retrieved. The visual analogue scale (VAS) score was used to register pain improvement after treatment.
Between January 2011 and December 2021, forty-seven patients (male: 26, mean age: 68.5 years) with SNPS (lumbar: 29, thoracic: 18) were hospitalized. The main co-morbidity was diabetes mellitus (23 patients). Pain was the predominant (46 patients), and fever was the second most common (19 patients) symptom. The most frequent causative microorganism was staphylococcus aureus (29 patients); no pathogen was identified in ten patients. The mean hospitalization duration for patients completing their conservative treatment (43/47) was 27 (range: 22-41) days. They received antibiotics for a mean period of 23 days intravenously (range: 21-29), 23.8 days (range: 21-35), and 46.8 days in total (range: 42-63). Conservative treatment was discontinued in two females. Two male patients died due to septic shock. The mean follow-up was 11.5 months (range: 6-15). During follow-up, no one developed any neurologic deficit and/or recurrence. There was a significant improvement in the mean VAS, from 8.3 ± 0.8 pre-treatment to 1.6 ± 0.5 at the latest follow-up (p <0.001).
Although treatment is gradually shifting towards surgical intervention, conservative therapeutic management of SNPS patients with antibiotic administration, bed rest, and careful mobilization remains a viable and efficacious option. HIPPOKRATIA 2023, 27 (2):106-111.
自发性非特异性化脓性脊椎椎间盘炎（SNPS）是一种罕见的病症，其最佳治疗方法仍存在争议。我们评估了我院实施的针对SNPS患者的保守治疗的多学科方案。
本回顾性审计研究纳入了腰椎或胸椎SNPS患者，这些患者开始接受保守治疗且至少随访了6个月。排除患有特异性、术后或医源性脊椎椎间盘炎或需要立即手术治疗的患者。收集感染部位、初始症状、合并症、病原体、抗生素治疗持续时间、住院和随访情况以及治疗结果。使用视觉模拟量表（VAS）评分记录治疗后疼痛的改善情况。
2011年1月至2021年12月期间，47例SNPS患者（男性26例，平均年龄68.5岁）住院治疗（腰椎29例，胸椎18例）。主要合并症为糖尿病（23例患者）。疼痛是主要症状（46例患者），发热是第二常见症状（19例患者）。最常见的致病微生物是金黄色葡萄球菌（29例患者）；10例患者未鉴定出病原体。完成保守治疗的患者（43/47）的平均住院时间为27天（范围：22 - 41天）。他们静脉使用抗生素的平均时间为23天（范围：
