Lv Hui, Zhou Jianhong, Guo Yuan, Liao Sheng, Chen Hui, Luo Fei, Xu Jianzhong, Zhang Zhongrong, Zhang Zehua
Department of Spine Surgery, Jiangbei Branch of Southwest Hospital, 958th Hospital of the PLA Army, Chongqing, China.
Department of Orthopaedic, Southwest Hospital, The First Affiliated Hospital of Army Medical University, Chongqing, China.
Asian Spine J. 2025 Apr;19(2):205-216. doi: 10.31616/asj.2025.0020. Epub 2025 Apr 7.
A retrospective study.
To evaluate the clinical efficacy of uniportal endoscopic decompression and debridement (UEDD) in treating infectious diseases of the spine (IDS) with neurological deficits.
IDS patients with neurological deficits often require urgent surgical decompression. However, the efficacy of UEDD in this complex patient population is not well-characterized.
This retrospective study analyzed 32 consecutive IDS patients who underwent UEDD surgery. Clinical features, laboratory data (erythrocyte sedimentation rate and C-reactive protein), and treatment outcomes were analyzed.
Definite microorganisms were identified in 27 patients (84.3%), with 24 (88.9%) meeting cure criteria. The cure rate was significantly higher in the detected pathogen group compared to the undetected pathogen group (88.9% vs. 80%; χ²=19.36, p<0.0001). Metagenomic next generation sequencing (mNGS) provided faster diagnosis (41.72±6.81 hours) compared to tissue culture (95.74±35.47 hours, p<0.05). The predominant causative pathogen was Mycobacterium tuberculosis, followed by Staphylococcus aureus. Significant improvements were observed in Visual Analog Scale pain scores, from a mean of 7.9 preoperatively to 1.06 at 1 year postoperatively. The Oswestry Disability Index revealed a similar trend, showing significant improvement (p<0.05).
UEDD is a viable alternative to traditional open surgery for managing IDS in high-risk patients. UEDD offers a dual therapeutic-diagnostic advantage during the initial admission phase, enabling simultaneous debridement, neurological decompression, and targeted biopsy in a single intervention. Compared with traditional tissue culture, mNGS enables rapid microbiological diagnosis and extensive pathogen coverage.
一项回顾性研究。
评估单孔内镜减压与清创术（UEDD）治疗伴有神经功能缺损的脊柱感染性疾病（IDS）的临床疗效。
伴有神经功能缺损的IDS患者通常需要紧急手术减压。然而，UEDD在这一复杂患者群体中的疗效尚未得到充分描述。
这项回顾性研究分析了32例连续接受UEDD手术的IDS患者。分析了临床特征、实验室数据（红细胞沉降率和C反应蛋白）及治疗结果。
27例患者（84.3%）鉴定出明确的微生物，其中24例（88.9%）达到治愈标准。与未检测到病原体的组相比，检测到病原体组的治愈率显著更高（88.9%对80%；χ²=19.36，p<0.0001）。与组织培养相比，宏基因组下一代测序（mNGS）诊断速度更快（41.72±6.81小时对95.74±35.47小时，p<0.05）。主要致病病原体为结核分枝杆菌，其次为金黄色葡萄球菌。视觉模拟评分法疼痛评分有显著改善，从术前平均7.9分降至术后1年的1.06分。奥斯威斯功能障碍指数显示出类似趋势，有显著改善（p<0.05）。
对于高危患者，UEDD是治疗IDS的一种可行的传统开放手术替代方案。UEDD在初次入院阶段具有双重治疗诊断优势，能够在一次干预中同时进行清创、神经减压和靶向活检。与传统组织培养相比，mNGS能够实现快速微生物诊断并覆盖广泛的病原体。
