PDF(Pubmed)
Abstract：
BACKGROUND: Minimally invasive posterior fixation surgery for pyogenic spondylitis is known to reduce invasiveness and complication rates; however, the outcomes of concomitant insertion of pedicle screws (PS) into the infected vertebrae via the posterior approach are undetermined. This study aimed to assess the safety and efficacy of PS insertion into infected vertebrae in minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis.
METHODS: This multicenter retrospective cohort study included 70 patients undergoing minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis across nine institutions. Patients were categorized into insertion and skip groups based on PS insertion into infected vertebrae, and surgical data and postoperative outcomes, particularly unplanned reoperations due to complications, were compared.
RESULTS: The mean age of the 70 patients was 72.8 years. The insertion group (n = 36) had shorter operative times (146 versus 195 min, p = 0.032) and a reduced range of fixation (5.4 versus 6.9 vertebrae, p = 0.0009) compared to the skip group (n = 34). Unplanned reoperations occurred in 24% (n = 17) due to surgical site infections (SSI) or implant failure; the incidence was comparable between the groups. Poor infection control necessitating additional anterior surgery was reported in four patients in the skip group.
CONCLUSIONS: PS insertion into infected vertebrae during minimally invasive posterior fixation reduces the operative time and range of fixation without increasing the occurrence of unplanned reoperations due to SSI or implant failure. Judicious PS insertion in patients with minimal bone destruction in thoracolumbar pyogenic spondylitis can minimize surgical invasiveness.
METHODS: This multicenter retrospective cohort study included 70 patients undergoing minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis across nine institutions. Patients were categorized into insertion and skip groups based on PS insertion into infected vertebrae, and surgical data and postoperative outcomes, particularly unplanned reoperations due to complications, were compared.
RESULTS: The mean age of the 70 patients was 72.8 years. The insertion group (n = 36) had shorter operative times (146 versus 195 min, p = 0.032) and a reduced range of fixation (5.4 versus 6.9 vertebrae, p = 0.0009) compared to the skip group (n = 34). Unplanned reoperations occurred in 24% (n = 17) due to surgical site infections (SSI) or implant failure; the incidence was comparable between the groups. Poor infection control necessitating additional anterior surgery was reported in four patients in the skip group.
CONCLUSIONS: PS insertion into infected vertebrae during minimally invasive posterior fixation reduces the operative time and range of fixation without increasing the occurrence of unplanned reoperations due to SSI or implant failure. Judicious PS insertion in patients with minimal bone destruction in thoracolumbar pyogenic spondylitis can minimize surgical invasiveness.
摘要：
背景：化脓性脊柱炎的微创后路固定手术可降低侵袭性和并发症发生率；然而，同时通过后路将椎弓根螺钉(PS)插入感染椎骨的结果尚不确定.这项研究旨在评估在胸腰椎化脓性脊柱炎的微创后路固定中，将PS插入感染的椎骨的安全性和有效性。
方法：这项多中心回顾性队列研究包括9个机构的70例接受微创后路固定治疗胸腰椎化脓性脊柱炎的患者。根据PS插入感染的椎骨，将患者分为插入组和跳跃组，手术数据和术后结果，特别是由于并发症而计划外的再次手术，进行了比较。
结果：70例患者的平均年龄为72.8岁。插入组（n=36）的手术时间较短（146对195分钟，p=0.032）和固定范围减小（5.4与6.9椎骨，p=0.0009）与跳跃组（n=34）相比。由于手术部位感染（SSI）或植入物失败，导致24％（n=17）的计划外再次手术；两组之间的发生率相当。据报道，跳过组的四名患者感染控制不佳，需要进行额外的前路手术。
结论：在微创后路固定过程中，将PS插入感染的椎骨可减少手术时间和固定范围，而不会增加由于SSI或植入物失败而导致的非计划再次手术的发生率。在胸腰椎化脓性脊柱炎中骨破坏最小的患者中正确插入PS可以最大程度地减少手术侵袭。
方法：这项多中心回顾性队列研究包括9个机构的70例接受微创后路固定治疗胸腰椎化脓性脊柱炎的患者。根据PS插入感染的椎骨，将患者分为插入组和跳跃组，手术数据和术后结果，特别是由于并发症而计划外的再次手术，进行了比较。
结果：70例患者的平均年龄为72.8岁。插入组（n=36）的手术时间较短（146对195分钟，p=0.032）和固定范围减小（5.4与6.9椎骨，p=0.0009）与跳跃组（n=34）相比。由于手术部位感染（SSI）或植入物失败，导致24％（n=17）的计划外再次手术；两组之间的发生率相当。据报道，跳过组的四名患者感染控制不佳，需要进行额外的前路手术。
结论：在微创后路固定过程中，将PS插入感染的椎骨可减少手术时间和固定范围，而不会增加由于SSI或植入物失败而导致的非计划再次手术的发生率。在胸腰椎化脓性脊柱炎中骨破坏最小的患者中正确插入PS可以最大程度地减少手术侵袭。
