Krishnan A, Dave B R, Degulmadi D, Mayi S, Rai R, Bang P, Dave M, Chauhan V, Bali S, Charde P, Anil A, Krishnan P
Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, India.
Department of Radiodiagnosis, Stavya Spine Hospital and Research Institute, Ahmedabad, India.
Malays Orthop J. 2024 Nov;18(3):16-26. doi: 10.5704/MOJ.2411.003.
Conservative and surgical approach timeline in post-operative spondylodiscitis (POS) following lumbar disc herniation (LDH) surgery is ill defined, and patients have a protracted recovery phase with social, psychological, and financial implications.
Retrospective analysis of patients operated by transforaminal lumbar interbody fusion (TLIF) in POS was done. Confirmed clinico-radiological diagnosed POS cases, not responding within three to four weeks were included. Normalisation of CRP and radiological stable reconstruction was assessed for objective clearance of POS and bony union.
Ninety-five patients were included in the study with minimum follow-up period of two years. The mean age was 51.63±13.63 years. There were organisms cultured in 55 patients (57.89%). The ODI improvement of the patients was noted to improve from 88.71±5.3 to 20.80±9.7 (8 weeks) and was incremental at 2 years follow-up (10.12±6.41) and maintained further at final follow-up at 9±4.3. Bony union achieved in all with stable reconstruction. The resumption of activities of daily living (ADL) was quick (15.90±8.20 days) and job (3.67±1.31 months) was achieved in all the patients. In poor outcomes, two patients didn't respond, and one patient died due to uncontrolled infection.
Early diagnosis and intervention is the key to effective management of POS. Utilisation of aggressive TLIF yields faster ADL resumption.
腰椎间盘突出症（LDH）手术后发生的术后脊椎椎间盘炎（POS）的保守和手术治疗方法的时间线尚不明确，患者恢复阶段漫长，会产生社会、心理和经济影响。
对接受经椎间孔腰椎椎体间融合术（TLIF）治疗的POS患者进行回顾性分析。纳入经临床放射学确诊为POS且在三到四周内无反应的病例。评估CRP正常化和放射学稳定重建情况，以客观判断POS清除和骨融合情况。
95例患者纳入研究，最短随访期为两年。平均年龄为51.63±13.63岁。55例患者（57.89%）培养出微生物。患者的ODI改善情况从88.71±5.3改善至20.80±9.7（8周），在2年随访时进一步改善（10.12±6.41），并在最终随访时维持在9±4.3。所有患者均实现骨融合且重建稳定。所有患者日常生活活动（ADL）恢复迅速（15.90±8.20天），工作恢复时间为（3.67±1.31个月）。预后较差的情况中，2例患者无反应，1例患者因感染无法控制死亡。
早期诊断和干预是有效管理POS的关键。积极采用TLIF可使ADL恢复更快。
