Abstract：
OBJECTIVE: To compare the clinical efficacy and prognosis differences between conservative treatment and surgical treatment in patients with non-serious neurologically intact pyogenic spondylitis (Nsi-Nsni-PS), and to provide theoretical reference for the clinical treatment of Nsi-Nsni-PS patients.
METHODS: A retrospective analysis was conducted on 112 cases of Nsi-Nsni-PS patients treated in our hospital from June 2016 to June 2021. According to different treatment methods, they were divided into conservative treatment group (53 cases) and surgical treatment group (59 cases). The general data, laboratory tests, imaging examinations, length of hospital stay, duration of antibiotic use, VAS for pain before and after treatment, ODI, local kyphotic angle correction of diseased vertebrae, and recurrence rate were collected and analyzed in both groups. SPSS 26.0 statistical software was used for analysis. Measurement data were expressed as mean ± standard deviation, and independent sample t-test or rank sum test was used for comparison between groups, while variance analysis was used for intra-group comparison. Count data were expressed as number (%) and compared between groups using chi-square test or Fisher\'s exact test. Mann-Whitney U test was used to evaluate the changes in local kyphotic angle between the two groups. A p value < 0.05 was considered statistically significant.
RESULTS: There were no significant differences in general data and imaging characteristics between the two groups (P > 0.05); there were no statistically significant differences in the positive culture rate of pathogens, length of hospital stay, duration of antibiotic use, treatment complications, WBC, CRP, ESR levels at admission and discharge, VAS and ODI at admission and last follow-up between the two groups (P > 0.05). The WBC and CRP levels of patients in the conservative group at discharge were lower than those in the surgical group (P < 0.05), and there was no significant difference in the decrease in inflammatory indicators (WBC, CRP, ESR) between the two groups (P > 0.05). By the last follow-up, the neurological function of patients in both groups had significantly improved compared to admission (P < 0.05), with 12 out of 15 ASIA grade D patients in the conservative group recovering to grade E, and 21 out of 25 grade D patients in the surgical group recovering to grade E, with no worsening of neurological function in either group. The differences in VAS and ODI scores at the last follow-up compared to before treatment were statistically significant in both groups (P < 0.05), and all patients regained normal activity. Compared with before treatment, the correction degree of local kyphotic angle in the surgical group at the last follow-up was 0.93 ± 4.94°, slightly higher than that in the conservative group (-0.83 ± 3.37°), and the difference was statistically significant(P < 0.05).
CONCLUSIONS: During our follow-up, we found that both conservative and surgical treatments achieved satisfactory clinical outcomes in patients with Nsi-Nsni-PS. Compared to conservative treatment, surgical intervention did not demonstrate significant advantages in reducing hospitalization time and antibiotic usage duration, increasing pathogen culture positivity rate, lowering treatment complications, or controlling recurrence. However, surgical intervention showed superiority in correcting the local kyphotic angle of spinal lesions, albeit with relatively increased surgical trauma, risks, and treatment costs. At the last follow-up, the surgical group did not exhibit better long-term efficacy. Therefore, when formulating clinical treatment strategies for patients with Nsi-Nsni-PS, it may be preferable to prioritize conservative treatment, supplemented by the use of sensitive or empiric antibiotics for infection management, to improve patient prognosis.
METHODS: A retrospective analysis was conducted on 112 cases of Nsi-Nsni-PS patients treated in our hospital from June 2016 to June 2021. According to different treatment methods, they were divided into conservative treatment group (53 cases) and surgical treatment group (59 cases). The general data, laboratory tests, imaging examinations, length of hospital stay, duration of antibiotic use, VAS for pain before and after treatment, ODI, local kyphotic angle correction of diseased vertebrae, and recurrence rate were collected and analyzed in both groups. SPSS 26.0 statistical software was used for analysis. Measurement data were expressed as mean ± standard deviation, and independent sample t-test or rank sum test was used for comparison between groups, while variance analysis was used for intra-group comparison. Count data were expressed as number (%) and compared between groups using chi-square test or Fisher\'s exact test. Mann-Whitney U test was used to evaluate the changes in local kyphotic angle between the two groups. A p value < 0.05 was considered statistically significant.
RESULTS: There were no significant differences in general data and imaging characteristics between the two groups (P > 0.05); there were no statistically significant differences in the positive culture rate of pathogens, length of hospital stay, duration of antibiotic use, treatment complications, WBC, CRP, ESR levels at admission and discharge, VAS and ODI at admission and last follow-up between the two groups (P > 0.05). The WBC and CRP levels of patients in the conservative group at discharge were lower than those in the surgical group (P < 0.05), and there was no significant difference in the decrease in inflammatory indicators (WBC, CRP, ESR) between the two groups (P > 0.05). By the last follow-up, the neurological function of patients in both groups had significantly improved compared to admission (P < 0.05), with 12 out of 15 ASIA grade D patients in the conservative group recovering to grade E, and 21 out of 25 grade D patients in the surgical group recovering to grade E, with no worsening of neurological function in either group. The differences in VAS and ODI scores at the last follow-up compared to before treatment were statistically significant in both groups (P < 0.05), and all patients regained normal activity. Compared with before treatment, the correction degree of local kyphotic angle in the surgical group at the last follow-up was 0.93 ± 4.94°, slightly higher than that in the conservative group (-0.83 ± 3.37°), and the difference was statistically significant(P < 0.05).
CONCLUSIONS: During our follow-up, we found that both conservative and surgical treatments achieved satisfactory clinical outcomes in patients with Nsi-Nsni-PS. Compared to conservative treatment, surgical intervention did not demonstrate significant advantages in reducing hospitalization time and antibiotic usage duration, increasing pathogen culture positivity rate, lowering treatment complications, or controlling recurrence. However, surgical intervention showed superiority in correcting the local kyphotic angle of spinal lesions, albeit with relatively increased surgical trauma, risks, and treatment costs. At the last follow-up, the surgical group did not exhibit better long-term efficacy. Therefore, when formulating clinical treatment strategies for patients with Nsi-Nsni-PS, it may be preferable to prioritize conservative treatment, supplemented by the use of sensitive or empiric antibiotics for infection management, to improve patient prognosis.
摘要：
目的：比较非严重神经系统完整化脓性脊柱炎（Nsi-Nsni-PS）患者保守治疗与手术治疗的临床疗效和预后差异。为Nsi-Nsni-PS患者的临床治疗提供理论参考。
方法：对我院2016年6月至2021年6月收治的112例Nsi-Nsni-PS患者进行回顾性分析。根据不同的治疗方法，分为保守治疗组(53例)和手术治疗组(59例)。一般数据，实验室测试,影像学检查,住院时间,抗生素使用的持续时间，治疗前后疼痛的VAS，ODI,病变椎骨的局部后凸角矫正，收集并分析两组的复发率。采用SPSS26.0统计软件进行分析。测量数据表示为平均值±标准偏差，组间比较采用独立样本t检验或秩和检验，而组间比较采用方差分析。计数数据表示为数量（%），并使用卡方检验或Fisher精确检验在组间进行比较。采用Mann-WhitneyU检验评价两组间局部后凸角的变化。P值<0.05被认为是统计学上显著的。
结果:两组患者一般资料及影像学特征比较差异无统计学意义(P>0.05);病原菌培养阳性率比较差异无统计学意义,住院时间,抗生素使用的持续时间，治疗并发症,WBC,CRP,入院和出院时的ESR水平，两组患者入院时及末次随访时的VAS、ODI差异无统计学意义(P>0.05)。保守组患者出院时WBC、CRP水平低于手术组(P<0.05),炎症指标的下降没有显着差异（WBC，CRP,ESR)两组间比较(P>0.05)。在最后的后续行动中，两组患者的神经功能均较入院时明显改善(P<0.05),保守组15名ASIAD级患者中有12名恢复到E级，手术组25例D级患者中有21例恢复到E级，两组神经功能均无恶化。末次随访时VAS、ODI评分与治疗前比较差异均有统计学意义(P<0.05),所有患者都恢复正常活动.与治疗前相比,手术组末次随访时局部后凸角矫正程度为0.93±4.94°,略高于保守组（-0.83±3.37°），差异有统计学意义(P<0.05)。
结论：在我们的随访期间，我们发现,Nsi-Nsni-PS患者的保守治疗和手术治疗均取得了满意的临床结局.与保守治疗相比,手术干预在减少住院时间和抗生素使用时间方面没有显示出显著优势,增加病原体培养阳性率，降低治疗并发症，或控制复发。然而,手术干预在纠正脊柱病变的局部后凸角方面具有优越性，尽管手术创伤相对增加，风险,和治疗费用。在最后一次随访中，手术组未表现出更好的长期疗效.因此,在为Nsi-Nsni-PS患者制定临床治疗策略时，最好优先考虑保守治疗，补充使用敏感或经验性抗生素进行感染管理，改善患者预后。
方法：对我院2016年6月至2021年6月收治的112例Nsi-Nsni-PS患者进行回顾性分析。根据不同的治疗方法，分为保守治疗组(53例)和手术治疗组(59例)。一般数据，实验室测试,影像学检查,住院时间,抗生素使用的持续时间，治疗前后疼痛的VAS，ODI,病变椎骨的局部后凸角矫正，收集并分析两组的复发率。采用SPSS26.0统计软件进行分析。测量数据表示为平均值±标准偏差，组间比较采用独立样本t检验或秩和检验，而组间比较采用方差分析。计数数据表示为数量（%），并使用卡方检验或Fisher精确检验在组间进行比较。采用Mann-WhitneyU检验评价两组间局部后凸角的变化。P值<0.05被认为是统计学上显著的。
结果:两组患者一般资料及影像学特征比较差异无统计学意义(P>0.05);病原菌培养阳性率比较差异无统计学意义,住院时间,抗生素使用的持续时间，治疗并发症,WBC,CRP,入院和出院时的ESR水平，两组患者入院时及末次随访时的VAS、ODI差异无统计学意义(P>0.05)。保守组患者出院时WBC、CRP水平低于手术组(P<0.05),炎症指标的下降没有显着差异（WBC，CRP,ESR)两组间比较(P>0.05)。在最后的后续行动中，两组患者的神经功能均较入院时明显改善(P<0.05),保守组15名ASIAD级患者中有12名恢复到E级，手术组25例D级患者中有21例恢复到E级，两组神经功能均无恶化。末次随访时VAS、ODI评分与治疗前比较差异均有统计学意义(P<0.05),所有患者都恢复正常活动.与治疗前相比,手术组末次随访时局部后凸角矫正程度为0.93±4.94°,略高于保守组（-0.83±3.37°），差异有统计学意义(P<0.05)。
结论：在我们的随访期间，我们发现,Nsi-Nsni-PS患者的保守治疗和手术治疗均取得了满意的临床结局.与保守治疗相比,手术干预在减少住院时间和抗生素使用时间方面没有显示出显著优势,增加病原体培养阳性率，降低治疗并发症，或控制复发。然而,手术干预在纠正脊柱病变的局部后凸角方面具有优越性，尽管手术创伤相对增加，风险,和治疗费用。在最后一次随访中，手术组未表现出更好的长期疗效.因此,在为Nsi-Nsni-PS患者制定临床治疗策略时，最好优先考虑保守治疗，补充使用敏感或经验性抗生素进行感染管理，改善患者预后。
