Fujita Ryo, Ytterberg Kajsa, Gerdhem Paul, MacDowall Anna
Uppsala University, Uppsala, Sweden.
Hokkaido University, Sapporo, Japan.
Eur Spine J. 2025 Jun 13. doi: 10.1007/s00586-025-09037-y.
Surgical intervention can be an option in the treatment of primary spinal infection as a means to control infection, improve severe paralysis and save lives. However, there is a knowledge gap regarding how the patients fare after restitution, in terms of patient-reported outcomes (PROMs). This study aims to assess the outcomes 1 year after surgical treatment for primary spinal infection using PROMs by analyzing data with available cases from the national Swedish spine registry (Swespine).
This retrospective case-control cohort study included 907 patients who underwent surgery for primary spinal infection, registered in Swespine between 2006 and 2023. Among them, 82 patients had complete baseline and one-year follow-up data. Variables included age, sex, BMI, mortality rate, reoperation rate, and preoperative and one-year postoperative scores for the EQ-5D index, EQ-visual analogue scale (VAS), and Numerical Rating Scale (NRS) for back/neck and leg/arm pain. Patient status at one year post-surgery were calculated using ANCOVA analysis and compared with a cohort of healthy controls (n = 273) and with the I year follow-up of patients surgically treated for degenerative lumbar spine disease (n = 89,478). Patients' return to work 1 year after the surgery were also assessed via postal questionnaires.
One year post-surgery, spinal infection patients showed significant improvements in the EQ-5D index, EQ-VAS, and NRS scores (p-values: <0.001, < 0.001, 0.002, 0.001). The EQ-5D index improvement exceeded the minimum clinically important difference (MCID) of 0.24, but NRS improvements fell below the MCID threshold of 2.5. Despite improvements, the postoperative EQ-5D index remained significantly lower in the spinal infection group than in population-based controls (control: 0.93, infection: 0.49; p < 0.001). Additionally, EQ-5D and EQ-VAS improvements were less pronounced compared to degenerative disease patients (infection: 0.51, 57.3; degenerative: 0.65, 67.2; p < 0.001). The reoperation rate was 18.2%, and half of the working patients (20/40) had not resumed work within a year.
Surgical treatment for spinal infection improves life quality and pain. However, pain relief remains suboptimal, as the improvements do not reach the MCID. One year postoperatively, PROMs in spinal infection patients remain worse than those in population-based controls and degenerative disease patients, suggesting persistent symptoms despite healing and restitution of the spinal infection.
手术干预可作为原发性脊柱感染治疗的一种选择，用于控制感染、改善严重瘫痪并挽救生命。然而，在患者康复后的情况方面，即患者报告结局（PROMs）方面，存在知识空白。本研究旨在通过分析瑞典国家脊柱登记处（Swespine）的可用病例数据，评估原发性脊柱感染手术治疗1年后的结局。
这项回顾性病例对照队列研究纳入了907例接受原发性脊柱感染手术的患者，这些患者于2006年至2023年在Swespine登记。其中，82例患者有完整的基线数据和1年随访数据。变量包括年龄、性别、体重指数、死亡率、再手术率，以及EQ-5D指数、EQ视觉模拟量表（VAS）和背部/颈部及腿部/手臂疼痛数字评定量表（NRS）的术前和术后1年评分。使用协方差分析计算术后1年患者的状况，并与一组健康对照者（n = 273）以及接受退行性腰椎疾病手术治疗患者的1年随访结果（n = 89,478）进行比较。还通过邮寄问卷评估患者术后1年的重返工作情况。
术后1年，脊柱感染患者的EQ-5D指数、EQ-VAS和NRS评分有显著改善（p值：<0.001、<0.001、0.002、0.001）。EQ-5D指数的改善超过了0.24的最小临床重要差异（MCID），但NRS的改善低于2.5的MCID阈值。尽管有所改善，但脊柱感染组术后的EQ-5D指数仍显著低于基于人群的对照组（对照组：0.93，感染组：0.49；p < 0.001）。此外，与退行性疾病患者相比，EQ-5D和EQ-VAS的改善不太明显（感染组：0.51，57.3；退行性疾病组：0.65，67.2；p < 0.001）。再手术率为18.2%，一半的在职患者（20/40）在1年内未恢复工作。
脊柱感染的手术治疗可改善生活质量和疼痛。然而，疼痛缓解仍未达到最佳效果，因为改善未达到MCID。术后1年，脊柱感染患者的PROMs仍比基于人群的对照组和退行性疾病患者差，这表明尽管脊柱感染已愈合和康复，但症状仍持续存在。
