后外侧入路病灶清除椎间植骨内固定联合闭式冲洗引流治疗原发性腰椎椎间隙感染

目的 分析后外侧入路病灶清除椎间植骨内固定联合闭式冲洗引流治疗原发性腰椎椎间隙感染的临床疗效。方法回顾性分析自2018-02—2020-02采用后外侧入路病灶清除椎间植骨内固定联合闭式冲洗引流手术治疗的20例原发性腰椎椎间隙感染,比较术前、术后2周、1个月、3个月、6个月疼痛VAS评分、JOA评分、ESR、CRP水平。结果 20例均顺利完成手术并获得至少6个月的随访,手术时间95～123 min,平均109.4 min,术中出血量160～300 mL,平均215.4 mL。病灶组织细菌培养结果显示金黄色葡萄球菌9例。术后4周降钙素原水平恢复正常,切口均一期愈合,植骨均获骨性融合,未出现复发感染的情况。术后6个月疼痛VAS评分、ESR、CRP水平较术前明显降低,JOA评分较术前增加,差异有统计学意义（P<0.05）。结论 后外侧入路病灶清除椎间植骨内固定联合闭式冲洗引流治疗原发性腰椎椎间隙感染具有治疗效果显著、病灶清除彻底、内固定可靠、创伤较小等优点,值得临床推广。     

原发性化脓性椎间隙感染发病机理及治疗方法的探讨

目的 :探讨化脓性椎间隙感染的发病机理及治疗方法。方法 :对 11例化脓性椎间隙感染的患者采取前路病灶清除、后路椎板间植骨术并结合大剂量抗生素运用、卧床、制动等方法治疗。结果 :术后 11例患者获得 1～ 2年的随访 ,感染无 1例复发 ,脊柱无后凸畸形 ,植入骨块融合。结论 :前路手术清除病灶、后路椎板间植骨以加强脊柱的稳定性是治疗化脓性椎间隙感染的有效方法。     

一期单纯后路和前后联合入路病灶清除植骨内固定术治疗脊柱结核的临床疗效对比

目的对比一期单纯后路和前后联合入路病灶清除植骨内固定术治疗脊柱结核的临床疗效。方法回顾性分析2011年1月—2015年1月本院收治的71例胸腰椎结核患者资料,行一期后路病灶清除植骨内固定术治疗37例(A组),行一期前路病灶清除植骨并后路内固定术治疗34例(B组)。2组患者术前均给予标准抗结核治疗2~3周,记录手术时间、术中出血量、住院天数、并发症发生率,以及手术前后红细胞沉降率(ESR)、C反应蛋白(CRP)、Cobb角和美国脊髓损伤协会(ASIA)分级。结果所有手术顺利完成,术后随访8~22个月,平均随访14个月。2组在手术前后Cobb角、ESR、CRP、ASIA分级、Cobb角纠正度及术后并发症发生率方面的差异均无统计学意义(P0.05)。A组在手术时间、术中出血量及住院天数方面均低于B组,差异有统计学意义(P0.05)。末次随访时所有患者均获得骨性融合,未出现结核复发及内固定松动、断裂等并发症。结论一期单纯后路病灶清除植骨内固定与前路病灶清除植骨并后路内固定治疗胸腰椎结核均可取得满意疗效,但单纯后路在手术时间、术中出血量及住院天数上均低于前后路联合入路,有明显优势。     

腰骶椎结核治疗的方法选择(附65例分析)

[目的]探讨腰椎结核治疗的方法选择。[方法]回顾分析65例腰椎结核患者采用五种不同治疗方法的疗效：A组（14例）单纯病灶清除术;B组（15例）病灶清除并植骨融合术;C组（9例）后路病灶清除植骨融合＋内固定术;D组（12例）后路内固定＋前路病灶清除植骨融合术;E组（15例）前路病灶清除植骨融合＋前路内固定术。术前、术后常规支持和抗结核治疗,并定期随访,观察血沉变化,摄X线平片,CT三维重建评估结核活动、骨块融合和畸形矫正情况。[结果]65例腰椎结核患者术中无大血管、神经、输尿管损伤,随访12～16个月,平均13个月,结核病变无复发,植骨全部融合,愈合时间4～6个月,平均3.8个月。后凸畸形矫正角度无明显丢失,内固定无松动、断裂等并发症。[结论]有效的抗痨是治疗结核的前提,彻底清除病灶是治疗的关键,融合、内固定与否,根据结核破坏的程度、部位而定,合理的选择能提高腰椎结核的治疗效果。     

椎间隙感染的治疗(附42例临床分析)

目的 评价不同方法治疗椎间隙感染的中远期疗效.方法 回顾分析42例椎间隙感染,随访治愈率、实验室指标、影像学检查及神经功能恢复情况.结果 非手术治疗治愈率为66.67%,一期病灶清除椎间植骨融合者治愈率为85.71%,一期病灶清除植骨内固定者治愈率为88.89%.3例神经损害平均恢复1.3级(Frankel分级).结论 前路病灶清除、一期植骨内固定治疗椎间隙感染可以明显缩短病程,防止植骨块移位,促进病变间隙融合.     

三种腰椎结核手术方式的比较研究

目的比较不同手术方式治疗腰椎结核的疗效。方法回顾分析2003-02-2010-08收治的88例腰椎结核患者,其中23例行一期前路病灶清除植骨融合内固定术,简称前路手术组(A组);25例行一期前路病灶清除植骨融合后路内固定术,简称前后路联合手术组(B组);40例行一期后路病灶清除植骨融合内固定术,简称后路手术组(C组)。随访8~24个月,平均15个月。通过记录和观察三组患者的手术时间、术中出血量、住院天数及手术前后的Frankel分级、Cobb’s角、ESR值变化情况,进行相互比较分析。结果所有病例切口均I期愈合,无严重并发症发生。在平均手术时间、平均术中出血、平均住院天数上,A/C、B/C组比较有显著性差异(P<0.01),A/B组比较无明显差异(P>0.05)。三组术前术后的Frankel分级、Cobb’s角及ESR值变化程度比较无明显差异(P>0.05)。结论在严格把握手术适应证的基础上,一期后路病灶清除植骨融合内固定术治疗腰椎结核与前路及前后路联合术式均可获得较好的治疗效果,但后路术式手术时间短、出血少、住院时间短,是一种安全可行、更方便的手术方式。     

不同手术入路治疗腰椎结核疗效分析

目的比较不同手术入路治疗腰椎结核手术效果。方法手术治疗158例腰椎结核患者,分别采用侧前路入路手术病灶清除植骨钢板内固定59例（A组）、后路病灶清除减压内固定49例（B组）、前路减压病灶清除后路内固定50例（C组）。观察手术时间、出血量、截瘫缓解情况、植骨融合情况、后凸畸形矫正情况。结果平均手术时间：A组（170.5±18.3）min,B组（130.3±26.8）min,C组（208.5±18.3）min;平均出血量：A组（520.4±53）ml,B组（535.8±62）ml,C组（750.6±91）ml。组间比较差异有统计学意义（P〈0.05）。随访9-24个月。3组均无严重并发症发生,A组1例出现结核脓肿复发,窦道形成,经前路脓肿清除后治愈,1例术中损伤髂总静脉,行修补术。末次随访时所有植骨均获骨性融合,无内固定松动及断裂出现。3组的ASIA分级、Cobb角变化程度比较差异无统计学意义（P〉0.05）。结论一期侧前路病灶清除植骨融合内固定术治疗胸腰椎结核,后路病灶清除植骨融合内固定术以及前后路联合术式均可获得较好的治疗效果,但手术入路的选择应根据病灶侵蚀的范围、节段、患者的耐受能力以及手术者的习惯来决定。     

一期极外侧入路病灶清除植骨融合闭式冲洗引流联合后路内固定术治疗原发性腰椎间隙感染

目的 :探讨一期极外侧入路病灶清除植骨融合闭式冲洗引流联合后路内固定术治疗原发性腰椎间隙感染的临床疗效。方法:回顾性分析2010年8月~2016年6月收治的23例原发性腰椎间隙感染患者的临床资料,其中男13例,女10例;年龄16~78岁(55.2±17.0岁)。均为单一腰椎间隙感染,其中L1/2 3例,L2/3 5例,L3/4 8例,L4/5 7例。均经保守治疗2周无效或效果不佳,均行一期极外侧入路病灶清除植骨融合闭式冲洗引流联合后路内固定术,术中留取病灶组织标本进行细菌培养及病理学检查,术后感染椎间隙持续闭式冲洗引流2~3周,术后抗生素应用4~6周。手术前后采用VAS评分评价腰痛程度,JOA评分评价神经功能,Barthel指数(BI)评价日常生活能力,检测血沉(ESR)、C反应蛋白(CRP)。术后定期复查腰椎X线片、CT,评价内固定和植骨融合情况。结果:均成功实施手术,术中及术后均未发生严重并发症。术后病灶组织细菌培养显示金黄色葡萄球菌2例、大肠埃希菌1例、肺炎克雷白杆菌1例、缓症链球菌1例,余18例均为阴性;病理检查结果均符合急慢性炎性反应表现。随访12~24个月(18.0±3.5个月)。术后1、3、6、12个月腰痛VAS评分、JOA评分、BI、ESR、CRP均较术前明显改善(P0.05)。随访期间无感染复发,无内固定松动,术后3~12个月(6.0±1.7个月)植骨均获骨性融合。结论:一期极外侧入路病灶清除植骨融合闭式冲洗引流联合后路内固定术治疗原发性腰椎间隙感染临床疗效满意,具有病灶清除彻底、植骨充分、操作安全的特点。     

前后联合入路病灶清除植骨融合内固定治疗腰椎结核

目的探讨采用前后联合入路病灶清除植骨融合内固定治疗腰椎结核的效果。方法对L2~5结核15例采用一期前路病灶清除植骨融合内固定术治疗。结果本组随访1~2年,无结核复发或内固定障碍等,椎间隙植骨均获骨性愈合,内固定位置正常。结论一期前路清除腰椎结核病灶彻底,椎管减压效果显著,植骨融合内固定可有效重建腰椎稳定性。     

一期前路病灶清除植骨内固定治疗脊柱结核

目的探讨经前路病灶清除植骨一期前路内固定术治疗脊柱结核的临床效果。方法对43例脊柱结核患者,行前路病灶彻底清除、椎间植骨、一期前路内固定术。结果脊柱结核复发2例（4.7%）,植骨不融合3例（7.0%）。植骨融合时间3～8个月。脊柱后凸畸形平均矫正70.2%±11.4%。11例截瘫患者神经功能Frankel分级术后恢复情况：术前A级3例术后恢复至B级1例、2例无恢复;B级5例恢复至C级1例、D级2例、E级1例、1例无恢复;C级3例恢复至D级1例、E级2例。结论经前路病灶清除植骨一期前路内固定术治疗脊柱结核能彻底清除结核病灶,充分减压,矫正脊柱后凸畸形,提高脊柱结核的治愈率。     

Suspected disk space infection with negative microbiological tests-report of eight cases and comparison with documented pyogenic discitis

Few data are available on patients with suspected noniatrogenic pyogenic discitis but negative microbiological tests. OBJECTIVES: To compare the features, treatment, and outcomes in patients with suspected versus microbiologically documented noniatrogenic pyogenic discitis. PATIENTS: A retrospective chart review identified eight patients with suspected noniatrogenic pyogenic discitis managed at our institution over a 15-year period. Eighteen age- and sex-matched patients with microbiologically documented noniatrogenic pyogenic discitis managed at our institution during the same period served as controls. RESULTS: The eight cases had a longer time to diagnosis, a greater risk of abscess formation or epidural infection, and a smaller number of cutaneous portals of entry, as compared to the controls. None of the cases had evidence of endocarditis or diabetes mellitus. Infection at another site preceded the discitis in half the cases. Empirical treatment with two antimicrobials (usually a fluoroquinolone with a beta-lactam or fosfomycin) ensured a full recovery in all eight cases, with no relapses or long-term recurrences, whereas relapses occurred in three of the 18 controls treated with antibiotics selected by antibiotic susceptibility testing. CONCLUSION: Noniatrogenic pyogenic discitis with negative microbiological studies is associated with distinctive clinical features consistent with smoldering infection. The outcome is favorable under empirical two-drug antimicrobial therapy, usually including a fluoroquinolone given by the intravenous route.     

Management of infectious discitis. Outcome in one hundred and eight patients in a University Hospital

Purpose  

The optimal management of pyogenic discitis is not agreed on. We conducted a retrospective, cross-sectional, observational study in which all patients with discitis who attended Hospital San Carlos Madrid from January 1999 to January 2009 were included.     

Extension of lumbar spine infection into osteoarthritic hip through psoas abscess

We present a case of pyogenic lumbar discitis and septic hip arthritis, accompanied by a psoas abscess and pyogenic iliopsoas bursitis, for which the correct diagnosis was delayed. The patho-mechanism was speculated to be initial hematogenous infection in the lumbar spine that spread along the psoas muscle as a psoas abscess and then extended into the hip joint via the iliopsoas bursa. For an early correct diagnosis, clinicians should be aware that the lumbar spine and hip joint regions communicate through the psoas muscle space and iliopsoas bursa, making it possible for infection to spread.     

兔椎间盘炎模型的建立

目的建立椎间盘炎的动物模型。方法采用新西兰大白兔12只,随机分为对照组、实验组,其中对照组4只、实验组8只。将一定量的金黄色葡萄球菌或等量生理盐水注入兔腰椎间隙,术后定期进行磁共振检查及实验区椎间盘组织细菌培养和常规病理学检查,对术后C-反应蛋白（CRP）进行动态观察,并与血沉（ESR）做对照分析。结果一周后注射金黄色葡萄球菌的所有动物均出现椎间盘炎发病,ESR、CRP均明显升高,MRI提示椎间盘炎改变。活检物细菌培养阳性,病理学检查证实有椎间盘炎发生。而注射生理盐水组无椎间盘炎发病。结论将一定量的金黄色葡萄球菌注入兔腰椎间隙可制做椎间盘炎模型,炎症反应明显,模型稳定。可用于人的椎间盘炎的病理学、外科学及药物治疗等多方面的类比实验。     

Presence of Modic type 1 change increases risk of postoperative pyogenic discitis following decompression surgery for lumbar canal stenosis

Study Design

Multicenter retrospective study.

Pyogenic infections of the adult spine.

A retrospective analysis of 61 patients forms the basis for this paper's comment on three major types of pyogenic spinal disease. The first group consists of 22 patients with vertebral osteomyelitis and intervertebral discitis. The second group comprises 22 patients in whom the diagnosis of pyogenic spinal disease was made only after failure of discectomy. In retrospect they were shown to have atypical degenerative disc disease and were similar to the first group. The third group of 17 patients, while demonstrating some similarities to the second group, represents true postdiscectomy wound infection. An understanding of the clinical presentation and pathophysiology of pyogenic disease of the spine allows it to be distinguished preoperatively from degenerative disc disease which superficially it resembles. Further, true postdiscectomy wound infection can be distinguished from pyogenic spinal disease misdiagnosed preoperatively. The differences in the results of treatment of these three groups warrant such distinctions.     

Management of nontuberculous infectious discitis. treatments used in 110 patients admitted to 12 teaching hospitals in France.

The optimal management of pyogenic discitis is not agreed on. No randomized clinical trials of short-course or oral antibiotic regimens have been published to date. To shed light on this issue, we reviewed the management of patients admitted for pyogenic discitis to one of 12 networked rheumatology departments. In this cross-sectional observational study, each department included the first ten patients admitted starting in January 1997 for treatment of pyogenic discitis. One hundred ten patients met the inclusion criteria, 67 men and 43 women, with a mean age of 60.6 +/- 13.7 years (range, 17-86 years). Mean time from symptom onset to diagnosis was 39.6 +/- 39.8 days (range, 24 h-240 days). Blood cultures were positive in 47.3% of patients, and the percutaneous discal and vertebral biopsy in 63.6% of cases; these two investigations identified the causative organism in 79 cases (72.8%). Mean duration of the rheumatology department stay was 31.3 +/- 14.1 days (range, 4-78 days). Antibiotics were given intravenously to 103 (93.6%) patients, for a mean of 25.5 +/- 17.6 days (range, 4-124 days); duration of intravenous antibiotic therapy was longer than 4 weeks in 36.5% of patients. Only seven (6.4%) patients received primary oral antibiotics with no parenteral antibiotics. One hundred patients were given oral antibiotics at the same time as and after intravenous antibiotics, for a mean duration of 87.2 +/- 43.6 day (range, 20-278 days); Bracing was used in 98 (89.1%) patients. Although antibiotic selection was rational and in agreement with current recommendations, wide differences were noted across centers regarding intravenous treatment duration, hospital stay duration, and total treatment duration.     

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.     

Pyogenic spondylitis as a complication of ear piercing: differentiating between spondylitis and discitis

We report what is, to our best knowledge, the first case of pyogenic spondylitis following ear piercing, a common and popular cosmetic procedure. The spondylitis was adequately treated with antibiotics and brace. The value of additional diagnostic measures in differentiating between spondylitis and discitis is discussed.     

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.