Successful treatment of extended epidural abscess and long segment osteomyelitis: a case report and review of the literature

BACKGROUND: Spinal osteomyelitis and epidural abscess are complicated medical conditions. Diagnosis is often delayed because of cormorbidity. The time of instrumentation is still controversial. However, there is no doubting the indication of spinal hardware implantation when spinal fusion is needed. Long segment osteomyelitis and extended epidural abscess are rare. The treatment is challenging for neurosurgeons. We report a case of extended epidural abscesses and long segments of osteomyelitis. METHODS: One-stage meticulous debridement, anterior cervical corpectomies, and spinal fusion with mesh cage and titanium plate were performed on the patient. Hyperbaric oxygenation and 6 weeks of intravenous antibiotics were prescribed as adjuvant therapy. RESULTS: Both clinical presentations and imaging studies showed a good response to the treatment. The patient returned to his life 3 months later. CONCLUSIONS: This case illustrates that spinal instrumentation is not an absolute contraindication in the presence of epidural abscesses and vertebral osteomyelitis. Combined surgical debridement at a critical level, with adjuvant antibiotics and hyperbaric oxygenation, is a safe and effective therapy in those with neurologic deficits, spinal instability, and extended epidural abscess.     

Single-stage treatment of pyogenic spinal infection with titanium mesh cages

STUDY DESIGN: Single institution retrospective review. OBJECTIVES: To report a series of pyogenic spinal infections treated with single-stage debridement and reconstruction with titanium mesh cages. SUMMARY OF BACKGROUND DATA: Various studies have reported surgical results of pyogenic spinal osteomyelitis with anterior debridement, strut grafting and fusion, including delayed posterior spinal instrumentation. Additionally, various authors have recommended against the use of instrumentation because of the concern about glycocalyx formation on the metal and chronic infection. At our institution, we routinely treat chronic vertebral osteomyelitis with single-stage debridement, reconstruction with a titanium mesh cage filled with allograft chips and demineralized bone matrix, and posterior pedicle screw instrumentation. To our knowledge, this is the largest single series reporting single-stage debridement and instrumentation of pyogenic spinal infection with titanium mesh cages and posterior instrumentation. MATERIALS AND METHODS: We retrospectively reviewed the patient records and radiographs of 21 consecutive patients (average age 49.3 years, range 23 to 80 years) with pyogenic vertebral osteomyelitis, all treated with titanium mesh cages. Average follow-up was 44 months (range, 25 to 70 months). Spinal levels included 6 thoracic, 4 thoracolumbar, 9 lumbar, and 2 lumbosacral (L5-S1) lesions. All patients had preoperative serum evaluation, which usually included blood cultures, complete blood count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), in addition to plain radiographs and magnetic resonance imaging. A positive needle biopsy was available in only 2/7 patients (29%), and overall, preoperative pathogen identification was available in only 7/21 patients (33%). All patients were treated postoperatively with a minimum of 6 weeks of intravenous antibiotics, with a specific antibiotic regimen directed toward the postoperative pathogen when identified (17/21 cases). Extensive radiographic evaluation was also performed. RESULTS: ESR and CRP were routinely elevated (18/20 and 11/17 cases respectively), whereas the white blood count was elevated in only 8 out of 21 cases (38%). The average duration of symptoms to diagnosis was approximately 13.6 weeks (range 3 weeks to 10 months). The indications for surgery included neurologic compromise, significant vertebral body destruction with loss of sagittal alignment, failure of medical treatment, and/or epidural abscess. All patients had resolution of infection, as noted by normalization of the ESR and CRP. Further, 16 out of 21 patients also had a significant reduction of pain. There were no deaths or new postoperative neurologic compromise. The most common pathogen was Staphylococcus aureus. Two patients required a second surgery (posterior irrigation and debridement) during the same admission for persistent wound drainage. Radiographically, the average segmental kyphosis (or loss of lordosis) was 11.5 degrees (range, 0 to 24 degrees) preoperatively, and +0.8 degrees (range, -3 to +5 degrees) at latest postoperative follow-up. There was an average of 2.2 mm cage settling (range, 0 to 5 mm) on latest follow-up. There were no instrumentation failures, signs of chronic infection, or rejection. CONCLUSIONS: Titanium mesh cages present a viable option for single-stage anterior surgical debridement and reconstruction of vertebral osteomyelitis, without evidence of chronic infection or rejection. When used in conjunction with pedicle screw instrumentation, there is minimal cage settling without loss of sagittal alignment.     

Preliminary results of staged anterior debridement and reconstruction using titanium mesh cages in the treatment of thoracolumbar vertebral osteomyelitis.

BACKGROUND CONTEXT: Vertebral osteomyelitis can be successfully treated with spinal immobilization and parenteral antibiotics. Failure of medical therapy may necessitate surgical treatment consisting of anterior debridement and structural anterior column reconstruction. Autologous structural bone graft has traditionally been the gold standard in anterior column reconstruction. Because of the morbidity related to graft harvest, vertebral body replacement cages have emerged as a viable option for reconstructing a deficient anterior column. PURPOSE: To evaluate the efficacy of titanium mesh cages in the reconstruction of anterior column defects in the presence of active pyogenic infection. STUDY DESIGN: Prospective case series. METHODS: Eleven patients underwent operative treatment for osteomyelitis of the thoracolumbar spine using staged anterior debridement and reconstruction with cylindrical titanium mesh cages followed by delayed posterior spinal fusion with pedicle screw instrumentation during a 2-year period. Patients were postoperatively evaluated clinically and radiographically. RESULTS: Follow-up averaged 17+/-9 months. Average increase in kyphosis of 10+/-6 degrees corresponding to 4+/-4 mm loss in the height (subsidence) of the anterior construct. One patient died during revision surgery for hardware failure. Seven of the remaining 10 patients have not required antibiotics after the initial postoperative course of treatment. Three patients are maintained on chronic suppressive therapy as a precaution. There has been no evidence of recurrence or residual infection in any patient. Seven of the 10 patients were pain free at latest follow-up. There has been one case of pseudarthrosis. CONCLUSION: Cylindrical titanium mesh can be used with consistently good results for large anterior column defect reconstructions even in the face of active pyogenic infection. In our cohort of patients with pyogenic vertebral osteomyelitis, the use of titanium mesh cages has not been associated with early recurrence of infection.     

Reversal of tetraplegia in patients with cervical osteomyelitis--epidural abscess using anterior debridement and fusion

OBJECTIVE: Aggressive anterior debridement and fusion has been advocated for the treatment of cervical osteomyelitis/epidural abscess (COEA) for many years. In this study we review our experiences with severely neurologically impaired (tetraplegic) patients with COEA. METHODS: From 1989-1999 we identified 20 cases of COEA treated with anterior debridement and fusion. Patients were identified from a prospectively maintained database. All inpatient and outpatient records were reviewed. Six patients were identified as being tetraplegic prior to surgery. Tetraplegia was defined as complete absence or only flicker movement of the extremities. RESULTS: The age range was 41 to 74. There were five men and one woman. Anterior corpectomy and fusion with either iliac crest auto- or allograft was performed in all patients. In four of six patients an anterior cervical plate was utilized for internal fixation. Four of six patients were ambulatory at last follow-up. CONCLUSION: Aggressive debridement and fusion in patients with COEA can result in successful outcomes even in patients who are tetraplegic prior to surgery.     

钛网充填异体骨植骨在颈椎结核治疗中的应用

目的 评价前路病灶清除植骨内固定治疗颈椎结核的手术中,采用钛网充填异体骨植骨的临床应用价值.方法 回顾性研究2002年1月至2007年1月间,行前路病灶清除植骨内固定手术治疗且随访2年以上的颈椎结核病例共32例.其中,男性18例,女性14例;年龄18～72岁,平均41.3岁.发病至就诊时间0.5～15.0个月,平均6.9个月.初治患者13例,复治患者19例.根据植骨来源不同分为A、B两组,A组17例采用钛网充填异体骨植骨,B组15例采用自体髂骨块植骨.随访时间2-5年,平均3.5年.比较两组间手术时间、出血量、结核治愈情况、颈椎生理曲度(ARA角)变化、颈脊髓功能(40分评分)及植骨融合率等.结果 切口一期愈合率93.8%(30/32),总治愈率为96.9%(31/32).A、B组间切口一期愈合率及总治愈率差异均无统计学意义(P>0.05).两组平均手术时间分别72、90 min,平均出血量分别为121、198 ml;两组比较差异均有统计学意义(P<0.05).两组组内比较,术前与术后即刻、术前与术后末次随访时、术后即刻与术后末次随访颈脊髓功能差异均有统计学意义(P<0.05);术前与术后即刻、术前与术后末次随访时颈椎绝对旋转角(ARA角)差异均有统计学意义(P<0.05),术后即刻与术后末次随访之ARA角差异均无统计学意义(P>0.05).两组组间比较:术前、术后即刻、术后末次随访之颈脊髓功能及ARA角差异均无统计学意义(P>O.05).结论 在个体化有效抗痨的基础上,应用前路病灶清除减压、一期钛网内充填异体骨植骨内固定治疗颈椎结核,临床疗效满意.     

一期前路病灶清除钛笼植骨内固定术治疗下颈椎结核

目的:探讨一期前路结核病灶清除钛笼植骨内固定治疗下颈椎结核的疗效。方法:2006年12月～2010年7月手术治疗下颈椎结核患者10例,男6例,女4例;年龄42～71岁,平均52.1岁。病灶累及2个椎体者7例,其中C3～C4 1例,C4～C5 1例,C5～C6 3例,C6～C7 2例;累及3个椎体者3例,均为C5～C7。术前均存在不同程度的颈部疼痛、低热、盗汗,6例患者伴有四肢感觉运动功能障碍,神经功能按Frankel评级:B级1例,C级2例,D级3例,E级4例。5例伴有寒性脓肿,脓液均未穿破后纵韧带。术前后凸Cobb角10°～30°(19.1°±5.1°)。术前应用抗结核药物治疗至少2周,均采用一期前路结核病灶清除钛笼植骨内固定手术,术后继续抗结核治疗6～12个月。随访观察患者临床症状改善和植骨融合情况。结果:手术均顺利完成,术中无大血管、脊髓、食道、气管损伤。切口均一期愈合,未发生感染及窦道形成。随访10～24个月,平均14.5个月,患者临床症状均改善,伴神经功能障碍患者均有不同程度的改善,1例从B级恢复到D级,其余均恢复至E级。颈椎后凸畸形矫正良好,术后1周后凸Cobb角为0°～5°(2.9°±1.6°),较术前明显减少,差异有统计学意义(P<0.01);末次随访时后凸Cobb角为0°～7°(4.7°±2.3°),与术后即刻比较差异无统计学意义(P>0.05)。术后3～6个月均显示良好的骨性融合征象,末次随访时钛笼植骨与上下椎体间完全融合,无内固定松动、脱落、折断等并发症。结论:在规范抗结核治疗的基础上,一期前路结核病灶清除钛笼植骨内固定治疗下颈椎结核是一种安全有效的方法。     

Two cases of pyogenic cervical discitis presenting tetraparesis

The authors reported two cases of pyogenic cervical discitis presenting tetraparesis. Case 1: A 66-year-old male patient entered the hospital because of tetraparesis. Two weeks before the hospitalization, he had become feverish and awakened with motor weakness in all extremities. Magnetic Resonance Imaging (MRI) study revealed a lesion filling the anterior epidural space from C4 to C6 levels and posterior displacement of the spinal cord. Findings suggesting discitis of C5/6 and osteomyelitis of C5 and C6 were also obtained on MRI. These findings suggested that the tetraparesis was caused by cord compression by the epidural abscess as the acute stage of pyogenic spinal infection. On the day following admission, surgical removal of the epidural abscess and of the infected bodies was performed. Spinal fusion through C4 to C7 was also carried out with iliac bone graft. Antibiotic administration and Halo-vest application were performed after the operation. The postoperative course was good and the tetraparesis had completely disappeared within 12 months after the operation. Case 2: A 60-year-old male patient entered the hospital because of tetraparesis. Since 6 weeks before the hospitalization, he had become feverish and suffered from pain in the neck. He had also awakened with motor weakness of all extremities. The tetraparesis was progressive. Plain X-ray films of the cervical spine showed destructive change of C5 and C6 and kyphotic displacement. An epidural abscess of the cervical spine at the level of C4 to C6, discitis of C5/6 and osteomyelitis of C5 and C6 were diagnosed on MRI findings. The disarranged kyphotic vertebral bodies and the epidural abscess caused posterior displacement of the spinal cord. Based on these findings, it was concluded that the abscess and the kyphotic change of the bodies had been induced by spinal infection in the subacute stage. On the 8th hospital day, surgical removal of the anterior portion of the infected bodies as well as fusion of the vertebral column from C4 to C7 was performed. Iliac bone was used for the fusion graft. Postoperative administration of antibiotics and Halo-vest application for external fixation were carried out. On the 7th postoperative day, symptoms caused by radiculopathy of the left C5 appeared, but gradually ameliorated. The patient was free from motor weakness in the 8th month after the surgical treatment. Surgical intervention is a useful treatment for pyogenic cervical discitis with symptoms due to compression of the spinal cord both in the acute and subacute stages.     

Surgical therapy of unspecific and specific Spondylodiscitis

AIM: The aim of this study was to evaluate the clinical and radiological results of surgical treatment of thoracic and lumbar vertebral osteomyelitis by means of one-stage extrafocal posterior stabilisation, anterior debridement, and anterior column reconstruction. METHOD: A retrospective analysis of the peri- and postoperative parameters of 62 patients with a clinical and radiographic follow-up of 2.6 years that were available for 46 patients was performed. In 42 cases, the anterior column was restored with structural bone grafts, in 20 patients, expandable titanium cages filled with morsellised autologous bone and antibiotic collagen sponges were used. To assess the course of spinal alignment a radiometric analysis was undertaken. Furthermore, the Roland-Morris score (RMS) was applied to evaluate the back pain-related disability. RESULTS: The diagnosis was made no earlier than 2.7 months after the first symptoms. Preoperatively, 40 % of the patients presented with neurological impairment, of these 76 % improved after surgery. Staphylococcus aureus was the most common pathogen isolated (32 %), Mycobacterium tuberculosis was found in 11 % of the patients. Except for one patient with revision for persistent infection and consecutive failure of the bone graft, primary eradication of the infection was achieved in all cases. At follow-up, bony fusion was radiographically observed in all patients. When using cages, the segmental loss of correction was significantly lower than when using bone grafts (1.0 vs. 4.1 degrees ). At follow-up the RMS averaged 6.6. CONCLUSION: One-stage extrafocal posterior stabilisation combined with anterior debridement and anterior column reconstruction with bone grafts or titanium cages is a safe and effective strategy for patients with vertebral osteomyelitis in need of surgery. Titanium cages have proven to be biomechanically advantageous, especially in cases of extensive destruction and are not associated with higher rates of persistence or recurrence of infection compared to autologous bone grafts.     

颈前路减压钛网带锁钢板重建对颈椎损伤和颈椎病作用的评价

目的评价运用颈椎前路减压钛网加带锁钢板内固定治疗颈椎伤病的临床效果.方法从2000年1月-2000年6月,运用钛网植骨、带锁钢板内固定重建技术,治疗17例颈椎损伤和颈椎病的病人.结果随访6～28个月,术后JOA评分改善平均13.6分.结论钛网加带锁钢板固定对颈椎伤病有良好固定作用,避免取髂骨,可显著提高植骨融合率,有效地维持椎间高度和生理曲度,有利于颈椎伤病患者的神经功能恢复和尽早行走.     

前路钢板结合钛网植骨在不稳定型下颈椎骨折治疗中的应用

目的观察钛网结合钛钢板内固定治疗不稳定型下颈椎骨折的临床效果。方法对36例不稳定型下颈椎骨折患者应用前路减压、钛网植骨加前路钢板固定,并对其疗效进行评价。结果所有患者随访4~28个月,平均随访17个月,按Frankel评分标准进行术前术后神经功能评定;围手术期无明显并发症,植骨均在术后12周达到临床愈合,颈椎生理曲度保持良好,无椎间盘高度的丢失,钛网无下沉、移位,钢板及螺钉无松动,无神经、血管并发症。术后3.5个月开始出现融合迹象,术后1年骨融合良好。结论不稳定型下颈椎骨折应用前路颈椎钢板固定技术结合钛网植骨治疗,颈椎生理曲度得到恢复,术后颈椎即时稳定性好,并能维持有效的椎间高度,植骨易于融合。通过自体椎体开槽减压取骨或加异体骨植骨避免了髂骨取骨所带来的损伤及手术时间的延长,且住院时间短,有利于患者的早期下床活动和功能恢复。手术病例及方法的选择应根据患者是否有致压因素及颈椎稳定性等情况综合考虑。     

椎间盘及部分椎体切除加钛网植骨钛板内固定术治疗单节段颈椎椎间盘突出伴椎体后缘骨赘

目的 评价颈椎椎间盘及相邻椎体部分切除加钛网植骨钛板内固定术治疗单节段颈椎椎间盘退变突出伴相邻椎体后缘骨赘的疗效. 方法 应用颈椎椎间盘及相邻椎体部分切除加钛网植骨钛板内固定术治疗单节段颈椎椎间盘退变突出伴相邻椎体后缘骨赘22例.取颈椎前路手术切口,术中仅切除突出的椎间盘及相邻椎体的1/3～ 1/2,使脊髓得到彻底的减压.再用填满碎骨的钛网植于骨缺损处加用钛板螺丝钉内固定,固定范围仅限于相邻椎体.术前和术后通过神经功能JOA评分、颈部轴性症状、颈椎动态侧位片和颈椎MRI比较临床疗效. 结果 均获随访,平均15(6 ～24)个月,术后JOA评分优良率86.4％,颈部轴性症状减轻,脊髓功能明显得到恢复.颈椎活动度良好.X线检查见钛网植骨及钛板内固定良好,未见不稳现象.MRI示颈髓压迫解除. 结论 颈椎椎间盘及相邻椎体部分切除加钛网植骨钛板内固定术治疗单节段颈椎椎间盘突出伴相邻椎体骨赘效果显著,可最大限度地保留颈椎节段的活动度.     

Anterior Column Reconstruction Using Titanium Ring Cages in Severe Vertebral Osteomyelitis

Abstract Background and Purpose: The use of instrumentation in spinal infections is still a controversial issue. The aim of the present study was to evaluate the efficiency of titanium cages in the surgical treatment of severe vertebral osteomyelitis (synonym spondylodiscitis) concerning eradication of the infection as well as biomechanical aspects. Materials and Methods: The peri- and postoperative data of 43 consecutive patients with vertebral osteomyelitis who underwent single-stage posterior stabilization, anterior debridement including decompression, and anterior column reconstruction using modular titanium ring cages filled with autologous bone were analyzed retrospectively. In 29 cases, a clinical and radiological follow-up of on average 2.5 years (median 2.2 years) was available. To assess the course of spinal alignment, a detailed radiometric analysis was performed. Results: The time of symptoms prior to surgery averaged 4.6 months. Preoperatively, 37% of the patients showed neurologic compromise with partial or complete recovery in 88% after surgery. In 25 patients (58%), a germ was isolated with Staphylococcus aureus being the most frequent pathogen (44%). Except for one patient with anterior revision and exchange of the cage for persistent infection, primary eradication of the infection was accomplished in all patients. At follow-up, all infections were eradicated, and all cages appeared radiographically fused. The present loss of correction in the sagittal plane amounted 1.5° at the affected segment(s) reconstructed by cage interposition and 4.4° at posterior fusion levels. Conclusion: Single-stage posterior instrumentation and fusion combined with anterior debridement and anterior column reconstruction using modular titanium ring cages represent a safe and efficient strategy in cases of severe vertebral osteomyelitis necessitating surgery. The use of titanium cages guarantees long-term maintenance of correction without increased risk of persistent or recurrent infection.     

颈前路钛网植骨及带锁钢板固定治疗下颈椎骨折

目的评价颈椎前路钛网植骨及带锁钢板固定治疗下颈椎骨折的临床应用价值。方法 2005年5月～2012年12月共收治下颈椎压缩性及爆裂性骨折患者32例,其中颈脊髓损伤患者28例,采用前路减压复位椎体次全切除、钛网植骨及带锁钢板固定方法一期手术治疗。按照Frankel评分系统对神经功能恢复情况进行评价,以X线片测量的Cobb角、"D"值改变评价复位效果、观察融合节段曲度及颈椎生理曲度重建和维持情况。结果不完全脊髓损伤患者Frankel评分恢复平均1级以上。Cobb角、"D"值测量统计表明术前与术后差异有统计学意义(P<0.05),术后即刻与术后随访差异无统计学意义(P>0.05)。结论颈前路钛网植骨及带锁钢板固定治疗下颈椎骨折临床疗效满意,能重建和维持颈椎生理曲度。     

颈椎前路椎体次全切除钛网植骨早期塌陷的探讨

目的探讨颈椎前路椎体次全切除减压钛网植骨钢板内固定患者钛网应用优缺点.方法57例脊髓型颈椎病患者,病变累及2个间隙49例,3个间隙5例,采用前路椎体次全切除减压钛网植骨并辅以4种不同带锁钢板内固定,其中Orion钢板25例,Zephir钢板11例,Coddman 10例,CSLP钢板11例.对其疗效及钛网融合情况进行评价.结果57例中51例获6～17月随访,植骨均在12周达到临床愈合,3例患者在术后6周发生钛网下沉,颈椎椎间高度降低,颈椎曲度减小,但术后病人主观感觉满意,3月后复查未见进一步下沉.结论钛网植骨比自体髂骨植骨有优越之处,但有发生下沉的可能.正确处理终板、合适的撑开高度、修剪面进行适当处理以及选择全锁定钢板,以降低下沉发生率.     

Anterior cervical debridement and strut-grafting for osteomyelitis of the cervical spine

A retrospective review of the surgical experience in treating 18 patients with osteomyelitis of the cervical spine is reported. The patients ranged in age from 20 to 60 years and all complained of neck pain upon admission. Ten patients had a prior history of intravenous drug abuse, three had previously suffered penetrating injuries of the neck, and one had an extraspinal site of osteomyelitis. Bacteria were isolated in 13 cases and tuberculosis in three. Neurological abnormalities were present in over one-half of the patients, consisting of myelopathy (nine cases) or radiculopathy (four cases). Plain cervical spine films and polytomography demonstrated vertebral and end-plate destruction, spinal instability, and increased paravertebral soft-tissue shadow in all cases. Computerized tomography and, more recently, magnetic resonance imaging have proven helpful in detecting bone involvement and the presence of epidural extension associated with cervical osteomyelitis. The risk of vertebral body collapse, kyphosis, and myelopathy in the osteomyelitic cervical spine has standardized the management of this problem in this institution to consist of skeletal traction, needle aspiration or blood culture for organism identification, anterior cervical debridement, autogenous iliac graft fusion, and intravenous administration of antibiotics. Spinal stability and neurological improvement were achieved in all 18 patients.     

Vertebral osteomyelitis. The surgical management of neurologic complications

Twelve patients with neurologic complications of vertebral osteomyelitis are reported. Initial symptoms were due to diffuse intraspinal abscesses (epidural or subdural) in six patients and to kyphotic deformities in three. A localized anterior subligamentous abscess was found in one patient and a similar abscess with kyphosis in one. Kyphosis and diffuse epidural abscess were found in one patient. Operations were designed to relieve cord compression and maintain or improve spinal stability. Outcome was good in eight patients and poor in two; two patients died. Delayed neurologic deterioration after laminectomy occurred in two patients who presented with epidural abscess and minimal signs of osteomyelitis due to subsequent development of anterior abscess and spinal deformity. Therapy of this problem is discussed, with emphasis on choice of technique for neural decompression. Adequate decompression with attention to stability will yield a good result in the majority of cases.     

颈前路钛网植骨融合术后钛网沉陷的原因探讨

目的：探讨颈前路钛网植骨融合术后钛网发生沉陷的原因及其对临床疗效的影响，并提出相应对策。方法：回顾性分析在我院行颈前路钛网植骨融合术的各类颈椎疾患患者179例，观察患者骨密度、钛网修剪及放置情况、终板处理情况、钢板类型、植骨及椎体撑开情况等。采用日本骨科学会（JOA）评分法评价神经功能的变化。结果：有17例患者发生钛网沉陷，沉陷的原因主要为骨密度下降、钛网修剪放置不当、术中过度撑开、终板刮除过多、使用非限制性钢板、采用同种异体骨植骨、螺钉进钉深度过浅和方向不当、钢板放置位置偏斜等。术后所有患者JOA评分比术前平均增加3．5分（P〈0．01）。162例未发生钛网下沉患者术后3个月和6个月的JOA评分比术前平均增加4．4分和4．7分：发生钛网下沉患者中。6例有临床症状者沉陷时和沉陷3个月时的JOA评分为2．9分和3．8分．7例无临床表现者为3．3分和3．9分．4例有临床症状行翻修手术者翻修术后1周和3个月时JOA评分比翻修前提高3．3分和3．7分。结论：颈前路钛网植骨融合术后可发生钛网下沉，骨质疏松患者应该避免使用钛网。手术时应尽可能增加钛网与终板接触面积，多保留相邻终板，选用限制性钢板，尽量选择自体骨植骨，避免椎间过度撑开等。防止术后钛网沉陷。     

前路钛钢板加钛网植骨内固定治疗多节段脊髓型颈椎病作用评价

目的：探讨前路钛钢板加钛网植骨内固定治疗多节段脊髓型颈椎病的效果及意义，方法：总结1998年至2002年期间收治的25例有2-3个节段突出的脊随型颈椎病行前路椎体次全切术前路钛钢板加钛网植骨内固定术，结果：经平均12个月的随访，25例患者植骨全部融合，无钛网移位脱落，无螺钉松动，钢板断裂，神经功能得到了不同程度恢复。结论：应用前路钛钢板加钛网植骨内固定术治疗有2-3个节段突出的脊髓型颈椎病是安全有效的。     

Hematogenous pyogenic spinal infections and their surgical management

STUDY DESIGN: Mainly a retrospective study of 101 cases of pyogenic spinal infection, excluding postoperative infections. Data were obtained through medical record review, imaging examination, and patient follow-up evaluation. SUMMARY OF BACKGROUND DATA: Hematogenous pyogenic spinal infection has been described variously as spondylodiscitis, discitis, vertebral osteomyelitis, and epidural abscess. Recommended treatment options have included conservative methods (antibiotics and bracing) and surgical intervention. However, a comprehensive classification that would aid in diagnosis, treatment planning, and prognosis has not yet been devised. OBJECTIVES: To analyze the bacteriology, pathologic entities, complications, and results of treatment options for pyogenic spinal infection. METHOD: All patients received plain radiographs, gadolinium-enhanced magnetic resonance imaging scans, and bone/gallium radionuclide studies. All patients had tissue biopsies. Bacteriology, hematology, and predisposing factors were analyzed. All patients received intravenous and oral antibiotics. A total of 58 patients underwent surgery. Patient outcomes were correlated with clinical status, with treatment method and, where applicable, with location and nature of epidural compression. Statistical analyses were performed. RESULTS: Spondylodiscitis occurred most commonly with primary epidural abscess, spondylitis, discitis, and pyogenic facet arthropathy, all occurring rarely. Staphylococcus aureus was the main organism. Infection elsewhere was the most common predisposing factor. Leukocyte counts were elevated in 42.6% of spondylodiscitis cases. The erythrocyte sedimentation rate was elevated in all cases of epidural abscess. There were 35 cases of epidural abscess (frank abscess, 29; granulation tissue, 6). Epidural abscess complicating spondylodiscitis occurred most often in the cervical spine, followed by thoracic and lumbar areas. The rate of paraplegia or paraparesis also was highest in cervical and thoracic regions. There were no cases of quadriplegia. All patients with either epidural granulation tissue or paraparesis recovered completely after surgical decompression. Only 18% of patients with frank epidural abscess and 23% of patients with paralysis recovered completely after surgical decompression. Patients with spondylodiscitis who were treated nonsurgically reported residual back pain more often (64%) than patients treated surgically (26.3%). CONCLUSIONS: Pyogenic spinal infection can be thought of as a spectrum of disease comprising spondylitis, discitis, spondylodiscitis, pyogenic facet arthropathy, and epidural abscess. Spondylodiscitis is more prone to develop epidural abscesses in the cervical spine (90%) than the thoracic (33.3%) or lumbar (23.6%) areas. Thecal sac neurocompression has a greater chance of causing neurologic deficit in the thoracic spine (81.8%). Treatment of neurologic deficit caused by epidural abscess is prompt surgical decompression, with or without fusion. Patients with frank abscess had less favorable outcomes than those with granulation tissue, and paraplegia responded to treatment more poorly than paraparesis. Surgery was preferable to nonsurgical treatment for improving back pain.     

颈前路椎体次全切钛网植骨钛网裁切技术探讨

目的探讨颈椎前路椎体次全切除减压钛网植骨钢板内固定患者术中钛网修剪的技巧以获得更好的接触面.方法47例脊髓型颈椎病患者,病变累及单间隙7例,双间隙40例,行前路椎体次全切除减压钛网植骨并辅以O-rion钢板内固定.术中根据钛网结构和所需长度进行设计,采用四种不同的方法进行剪切.结果47例中43例获6～18月随访,植骨均在12周达到临床愈合,未见钛网下沉、颈椎椎间高度及曲度改变.结论通过针对不同长度的特殊设计和钛网剪切,增加钛网接触面积,可以减少因接触面原因导致的钛网下沉.