Di Rienzo Alessandro, Carrassi Erika, Colasanti Roberto, Chiapponi Mario, Veccia Salvatore, Liverotti Valentina, Dobran Mauro
Department of Neurosurgery, Polytechnic University, Umberto I Hospital, Marche, Ancona, Italy.
Department of Neurosurgery, Santa Maria Della Misericordia Hospital, Rovigo, Italy.
Neurosurg Rev. 2025 Mar 31;48(1):340. doi: 10.1007/s10143-025-03503-3.
The optimal management of spondylodiscitis is still controversial. Large spectrum or targeted antibiotic therapy is the first option in neurologically intact patients, while surgery is reserved for cases of intractable pain, acute neurological defects and bone destruction-related spinal instability. Treatment failure due to lack of diagnosis may lead to infection persistence and progression, causing patients to shift from the medical to the surgical arm. In a 10 years' time, we treated 84 patients affected by primary spontaneous pyogenic spondylodiscitis. Forty-two patients underwent antibiotic therapy alone, 42 posterior fixation/decompression and disc debridement. At admission, we assessed all patients for neurological deficits and pain intensity, using appropriate imaging to rule out instability/neural compression. We compared the two groups in terms of pain control, mobilization, length of hospital stay, antibiotic therapy, and complications. Patients undergoing surgical treatment presented significantly shorter hospital stay, earlier and better pain control, faster mobilization from bed, shorter use of brace and shorter antibiotic therapy courses. No major complications occurred in both groups, while one revision was performed due to wound failure. In agreement with our results, posterior vertebral decompression and fixation should be considered a viable option in cases of spondylodiscitis with severe pain and/or neurological impairment. The operated patients fared clinically well (despite starting from worse clinical conditions than their medical counterparts) and the complication rate was negligible.
脊柱椎间盘炎的最佳治疗方案仍存在争议。广谱或靶向抗生素治疗是神经功能完好患者的首选，而手术则适用于顽固性疼痛、急性神经功能缺损以及与骨质破坏相关的脊柱不稳定病例。因诊断不足导致的治疗失败可能会使感染持续并进展，从而使患者从内科治疗转向外科治疗。在10年的时间里，我们治疗了84例原发性自发性化脓性脊柱椎间盘炎患者。42例患者仅接受抗生素治疗，42例接受后路固定/减压及椎间盘清创术。入院时，我们评估了所有患者的神经功能缺损和疼痛强度，并使用适当的影像学检查排除不稳定/神经受压情况。我们比较了两组患者在疼痛控制、活动能力、住院时间、抗生素治疗及并发症方面的情况。接受手术治疗的患者住院时间明显缩短，疼痛控制更早且更好，从床上活动的速度更快，支具使用时间更短，抗生素治疗疗程更短。两组均未发生重大并发症，仅1例因伤口愈合不良进行了翻修手术。与我们的结果一致，对于伴有严重疼痛和/或神经功能损害的脊柱椎间盘炎病例，后路椎体减压和固定应被视为一种可行的选择。接受手术治疗的患者临床预后良好（尽管其初始临床状况比接受内科治疗的患者更差），且并发症发生率可忽略不计。
