Chang Chao-Chien, Chang Hsiao-Kang, Lu Meng-Ling, Wegner Adam, Wu Re-Wen, Yin Tsung-Cheng
Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Department of Orthopaedic Surgery, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan.
Asian Spine J. 2025 Feb;19(1):38-45. doi: 10.31616/asj.2024.0388. Epub 2025 Jan 20.
A retrospective cohort study.
To evaluate whether using antibiotic-impregnated bone graft (AIBG) enhances infection control and shortens the postoperative course of pyogenic discitis and vertebral osteomyelitis (PDVO).
Surgical treatment of PDVO is indicated for neurological deficit, instability, unknown pathogen, or poorly controlled infection. The posterior-only approach is effective but requires 4-6 weeks of antibiotic treatment postoperatively. We hypothesized that AIBG used in an all-posterior approach could enhance infection control and shorten the postoperative course of PDVO.
Thirty patients with PDVO of the lumbar or thoracic spine treated with transforaminal interbody debridement and fusion (TIDF) with AIBG between March 2014 and May 2022 were reviewed (AIBG group). For comparative analysis, 28 PDVO patients who underwent TIDF without AIBG between January 2009 and June 2011 were enrolled (non-AIBG group). The minimum follow-up duration was 2 years. Clinical characteristics and surgical indications were comparable in the two groups. C-reactive protein (CRP) levels and the postoperative antibiotics course were compared between the two groups.
Surgical treatment for PDVO resulted in clinical improvement and adequate infection control. Despite the shorter postoperative intravenous antibiotic duration (mean: 19.0 days vs. 39.8 days), the AIBG group had significantly lower CRP levels at postoperative 4 and 6 weeks. The mean Visual Analog Scale pain scores improved from 7.3 preoperatively to 2.2 at 6 weeks postoperatively. The average angle correction at the last follow-up was 7.9°.
TIDF with AIBG for PDVO can achieve local infection control with a faster reduction in CRP levels, leading to a shorter antibiotic duration.
一项回顾性队列研究。
评估使用抗生素浸渍骨移植（AIBG）是否能加强感染控制并缩短化脓性椎间盘炎和椎体骨髓炎（PDVO）的术后病程。
PDVO的手术治疗适用于神经功能缺损、不稳定、病原体不明或感染控制不佳的情况。单纯后路手术有效，但术后需要4至6周的抗生素治疗。我们假设在全后路手术中使用AIBG可以加强感染控制并缩短PDVO的术后病程。
回顾了2014年3月至2022年5月间30例接受经椎间孔椎体间清创融合术（TIDF）并使用AIBG治疗的腰椎或胸椎PDVO患者（AIBG组）。为进行对比分析，纳入了2009年1月至2011年6月间28例接受TIDF但未使用AIBG的PDVO患者（非AIBG组）。最短随访时间为2年。两组的临床特征和手术指征具有可比性。比较了两组的C反应蛋白（CRP）水平和术后抗生素疗程。
PDVO的手术治疗带来了临床改善和充分的感染控制。尽管术后静脉使用抗生素的时间较短（平均：分别为19.0天和39.8天），但AIBG组在术后4周和6周时的CRP水平显著更低。视觉模拟评分法的平均疼痛评分从术前的7.3分改善至术后6周时的2.2分。最后一次随访时的平均角度矫正为7.9°。
使用AIBG进行TIDF治疗PDVO可实现局部感染控制，CRP水平更快下降，从而缩短抗生素疗程。
