Abstract：
OBJECTIVEInfection of the cervical spine is a rare disease but is associated with significant risk of neurological deterioration, morbidity, and a poor response to nonsurgical management. The ideal treatment for cervical spondylodiscitis (CSD) remains unclear.METHODSHospital records of patients who underwent acute surgical management for CSD were reviewed. Information about preoperative neurological status, surgical treatment, peri- and postoperative processes, antibiotic treatment, repeated procedure, and neurological status at follow-up examination were analyzed.RESULTSA total of 30 consecutive patients (17 male and 13 female) were included in this retrospective study. The mean age at procedures was 68.1 years (range 50-82 years), with mean of 6 coexisting comorbidities. Preoperatively neck pain was noted in 21 patients (70.0%), arm pain in 12 (40.0%), a paresis in 12 (40.0%), sensory deficit in 8 (26.7%), tetraparesis in 6 (20%), a septicemia in 4 (13.3%). Preoperative MRI scan revealed a CSD in one-level fusion in 21 patients (70.0%), in two-level fusions in 7 patients (23.3%), and in three-level fusions in 2 patients (6.7%). In 16 patients an antibiotic treatment was initiated prior to surgical treatment. Anterior cervical discectomy and fusion with cervical plating (ACDF+CP) was performed in 17 patients and anterior cervical corpectomy and fusion (ACCF) in 12 patients. Additional posterior decompression was performed in one case of ACDF+CP and additional posterior fixation in ten cases of ACCF procedures. Three patients died due to multiple organ failure (10%). Revision surgery was performed in 6 patients (20.7%) within the first 2 weeks postoperatively. All patients received antibiotic treatment for 6 weeks. At the first follow-up (mean 3 month) no recurrent infection was detected on blood workup and MRI scans. At final follow-up (mean 18 month), all patients reported improvement of neck pain, all but one patients were free of radicular pain and had no sensory deficits, and all patients showed improvement of motor strength. One patient with preoperative tetraparesis was able to ambulate.CONCLUSIONSCSD is a disease that is associated with severe neurological deterioration. Anterior cervical surgery with radical debridement and appropriate antibiotic treatment achieves complete healing. Anterior cervical plating with the use of polyetheretherketone cages has no negative effect of the healing process. Posterior fixation is recommended following ACCF procedures.
摘要：
目的颈椎感染是一种罕见的疾病，但与神经系统恶化的显著风险相关。发病率，对非手术管理反应不佳。颈椎病（CSD）的理想治疗方法尚不清楚。方法回顾了接受CSD急性手术治疗的患者的医院记录。关于术前神经状况的信息，手术治疗,围手术期和术后进程，抗生素治疗,重复程序，并对随访时的神经系统状况进行分析。结果本回顾性研究共纳入30例连续患者（男性17例，女性13例）。手术时的平均年龄为68.1岁（范围为50-82岁），平均有6种并存的合并症。术前颈部疼痛21例(70.0%),12例手臂疼痛（40.0%），12例(40.0%)出现轻瘫，8人的感觉缺陷（26.7%），在6（20％），4例败血症（13.3%）。术前MRI扫描显示21例（70.0％）在一级融合中出现CSD，在7例患者(23.3%)的两级融合中，2例患者（6.7％）的三级融合。在16名患者中，在手术治疗之前开始了抗生素治疗。17例患者进行了颈椎前路椎间盘切除和颈椎钢板融合（ACDFCP），12例患者进行了颈椎前路椎体切除和融合（ACCF）。在1例ACDFCP中进行了额外的后路减压，在10例ACCF手术中进行了额外的后路固定。3例患者因多器官功能衰竭死亡（10%）。6例（20.7%）在术后前2周内进行了翻修手术。所有患者均接受抗生素治疗6周。在第一次随访（平均3个月）时，血液检查和MRI扫描均未发现复发性感染。在最后一次随访（平均18个月），所有患者报告颈部疼痛改善，除一名患者外，所有患者都没有神经根性疼痛，没有感觉障碍，所有患者均表现出运动强度的改善。一名术前四瘫患者能够走动。结论SCSD是一种与严重神经系统恶化相关的疾病。颈椎前路手术，根治性清创和适当的抗生素治疗可实现完全愈合。使用聚醚醚酮笼的颈椎前板对愈合过程没有负面影响。建议在ACCF手术后进行后路固定。
