Segbedji Felix Kossi Kouma, Mallereau Charles-Henry, Dannhoff Guillaume, Dembour Victoria, Cebula Helene, Ganau Mario, Todeschi Julien, Cerase Alfonso, Muzii Vitaliano Francesco, Zalaffi Alessandro, Carangelo Biagio Roberto, Moruzzi Franco, Spatola Giorgio, Zaed Ismael, Cardia Andrea, Romano Antonio, Castellani Paola, Tarantino Francesca, Chibbaro Salvatore
Neurosurgery Department Sylvanus, Olympio University Hospital, Lomé, Togo.
Neurosurgery department Strasbourg University Hospital, Hautepierre University Hospital, 2 Avenue de Molière, Strasbourg, France.
Neurosurg Rev. 2025 Jan 8;48(1):29. doi: 10.1007/s10143-025-03191-z.
The urgent etiological diagnosis represents the main management objective of cervical spondylodiscitis (CSD) to start as soon as possible antibiotic treatment to prevent neurological deterioration. The present study aimed to evaluate a multicenter experience implementing a minimally invasive surgical approach (MISA) to manage CSD such pathology vs the most complex and aggressive surgical strategies currently used.This retrospective multicenter study used a database of 70 patients from five European neurosurgical centers. Patients with primary CSD underwent MISA via a limited funnel shaped cervical microdiscectomy with 4-mm anterior and 6-mm posterior longitudinal ligaments incision, PUS drainage, and extensive washing of the interbody and epidural space without fusion. Diagnosis was confirmed by clinical, imaging, laboratory, and perioperative histopathology and bacteriology.Of the 70 patients, 41 were men (58,5%), with an average age of 47.67 years. Severe neck pain affected 45 patients, while 51 had single-level cervical spondylodiscitis, 14 had double-level, and 5 had triple-level involvement. Staphylococcus aureus was identified in 49 cases. Each patient received a mean of three months of antibiotics. Inflammatory markers (C-reactive protein) were moderate for four weeks, then normalized by 8-12 weeks, except in one recurrence. After an average 48-month follow-up, all patients fully recovered without neurological deficit, spinal instability, or kyphotic deformity. Radiological exams confirmed bony fusion, with no recurrences of infection. MISA treatment offers a valuable, stable, and less invasive option for treating CSD, effectively identifying causative microorganisms and decompressing the spinal cord, leading to excellent patient outcomes.
紧急病因诊断是颈椎椎间盘炎（CSD）主要的治疗目标，即尽快开始抗生素治疗以防止神经功能恶化。本研究旨在评估采用微创外科手术方法（MISA）治疗此类CSD病变的多中心经验，并与目前使用的最复杂、最激进的手术策略进行对比。这项回顾性多中心研究使用了来自五个欧洲神经外科中心的70例患者的数据库。原发性CSD患者通过有限的漏斗形颈椎显微椎间盘切除术接受MISA治疗，切开4毫米前纵韧带和6毫米后纵韧带，进行经皮穿刺引流（PUS），并对椎间和硬膜外间隙进行广泛冲洗，不进行融合。通过临床、影像学、实验室及围手术期组织病理学和细菌学检查确诊。70例患者中，41例为男性（58.5%），平均年龄47.67岁。45例患者有严重颈部疼痛，51例为单节段颈椎椎间盘炎，14例为双节段，5例为三节段受累。49例病例中鉴定出金黄色葡萄球菌。每位患者平均接受了三个月的抗生素治疗。炎症标志物（C反应蛋白）在四周内处于中等水平，然后在8至12周恢复正常，但有1例复发除外。平均48个月的随访后，所有患者均完全康复，无神经功能缺损、脊柱不稳定或后凸畸形。影像学检查证实有骨融合，无感染复发。MISA治疗为CSD治疗提供了一种有价值、稳定且侵入性较小的选择，能有效识别致病微生物并使脊髓减压，从而带来出色的患者预后。
