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, 555 Otsuka, Chikusei, Ibaraki, 308-0813, Japan.
BMC Musculoskelet Disord. 2024 Oct 29;25(1):860. doi: 10.1186/s12891-024-07993-y.
The current study aimed to evaluate the bone union rate between infected vertebrae after minimally invasive posterior fixation without bone grafting in thoracolumbar pyogenic spondylitis.
This retrospective multicenter cohort study evaluated 75 patients of posterior fixation for thoracolumbar pyogenic spondylitis that have been recorded at six relevant institutions from January 2016 to December 2022. Data on age, sex, location of infected vertebrae, number of infected disks, comorbidity, Pola classification, number of vertebrae fixed according to surgery, implant failure requiring revision surgery, and distance according to the type of infected vertebrae after surgery were evaluated. Further, their association with postoperative bone union was investigated > 12 months postoperatively.
Finally, 40 patients were included in the study. In total, 32 (80%) patients achieved bone union at the infected vertebrae after minimally invasive posterior fixation without bone grafting. The mean duration from surgery to union was 10.7 months. Twenty-six (65%) patients initially achieved bone union at the lateral and/or anterior bridging callus. Patients with multiple-level infected disks (33%, 2/6 patients) had a lower bone union rate than those with a single-level infected disk (88%, 30/34 patients) (p = 0.0095).
In 80% of patients, bone union at the infected vertebrae was achieved after minimally invasive posterior fixation without bone grafting in thoracolumbar pyogenic spondylitis. A total of 65% of the patients achieved initial bone union at the lateral and/or anterior bridging callus. Moreover, patients with multiple-level infected disks had a low bone union rate. Hence, the treatment strategy should be cautiously considered.
This study was registered retrospectively and all procedures used in this study including the review of patient records were approved by the institutional review board.
本研究旨在评估微创后路固定治疗无植骨的胸腰椎化脓性脊柱炎感染椎体的骨融合率。
这是一项回顾性多中心队列研究，纳入了 2016 年 1 月至 2022 年 12 月在六家相关机构记录的 75 例微创后路固定治疗胸腰椎化脓性脊柱炎的患者。评估的指标包括年龄、性别、感染椎体的位置、感染椎间盘的数量、合并症、Pola 分类、根据手术固定的椎体数量、因植入物失败需要翻修手术的数量以及根据感染椎体类型术后的距离。进一步调查这些因素与术后>12 个月骨融合的相关性。
最终纳入 40 例患者。在微创后路固定治疗无植骨的胸腰椎化脓性脊柱炎中，共有 32 例（80%）患者在感染椎体处达到骨融合。从手术到融合的平均时间为 10.7 个月。26 例（65%）患者最初在侧方和/或前方桥接性骨痂处达到骨融合。多发节段感染椎间盘的患者（33%，2/6 例）的骨融合率低于单发节段感染椎间盘的患者（88%，30/34 例）（p=0.0095）。
微创后路固定治疗无植骨的胸腰椎化脓性脊柱炎，80%的患者感染椎体达到骨融合。65%的患者最初在侧方和/或前方桥接性骨痂处达到骨融合。此外，多发节段感染椎间盘的患者骨融合率较低。因此，应谨慎考虑治疗策略。
本研究为回顾性注册，本研究中使用的所有程序包括对病历的审查均获得机构审查委员会的批准。
