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首页> 外文期刊>Journal of orthopaedics and traumatology: official journal of the Italian Society of Orthopaedics and Traumatology >Adjacent segment infection after surgical treatment of spondylodiscitis
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Adjacent segment infection after surgical treatment of spondylodiscitis

机译：脊椎盘炎手术治疗后邻近节段感染

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This is the first case series to describe adjacent segment infection (ASI) after surgical treatment of spondylodiscitis (SD). Patients with SD, spondylitis who were surgically treated between 1994 and 2012 were included. Out of 1187 cases, 23 (1.94 %) returned to our institution (Zentralklinik Bad Berka) with ASI: 10 males, 13 females, with a mean age of 65.1 years and a mean follow-up of 69 months. ASI most commonly involved L3–4 (seven patients), T12–L1 (five) and L2–3 (four). The mean interval between operations of primary infection and ASI was 36.9 months. All cases needed surgical intervention, debridement, reconstruction and fusion with longer instrumentation, with culture and sensitivity-based postoperative antimicrobial therapy. At last follow-up, six patients (26.1 %) were mobilized in a wheelchair with a varying degree of paraplegia (three had pre-existing paralysis). Three patients died within 2 months after the ASI operation (13 %). Excellent outcomes were achieved in five patients, and good in eight. Adjacent segment infection after surgical treatment of spondylodiscitis is a rare complication (1.94 %). It is associated with multimorbidity and shows a high mortality rate and a high neurological affection rate. Possible explanations are: haematomas of repeated micro-fractures around screw loosening, haematogenous spread, direct inoculation or a combination of these factors. ASI may also lead to proximal junctional kyphosis, as found in this series. We suggest early surgical intervention with anterior debridement, reconstruction and fusion with posterior instrumentation, followed by antimicrobial therapy for 12 weeks. Level IV retrospective uncontrolled case series.
机译：这是描述脊柱椎间盘炎（SD）手术治疗后相邻节段感染（ASI）的第一个病例系列。纳入1994年至2012年间接受手术治疗的SD，脊柱炎患者。在1187例病例中，有23例（1.94％）的ASI患者返回我们的机构（Zentralklinik Bad Berka）：男10例，女13例，平均年龄65.1岁，平均随访69个月。 ASI最常涉及L3-4（七名患者），T12-L1（五名）和L2-3（四名）。原发感染和ASI的平均手术间隔为36.9个月。所有病例均需要手术干预，清创，重建和融合，需要更长的仪器，并需进行基于文化和敏感性的术后抗菌治疗。在最后一次随访中，有6名患者（26.1％）被移动到了截瘫程度不同的轮椅上（其中3名曾存在过瘫痪）。 ASI手术后2个月内有3例患者死亡（13％）。五名患者达到了极好的结果，八名患者得到了好的结果。脊椎盘炎的手术治疗后相邻节段感染是一种罕见的并发症（1.94％）。它与多发病有关，并显示出高死亡率和高神经病学发病率。可能的解释是：螺钉松动，血肿性扩散，直接接种或这些因素共同引起的反复微小骨折的血肿。如本系列所示，ASI也可能导致近端结节性驼背。我们建议早期手术，前路清创术，重建术和后路器械融合术，然后进行抗菌治疗12周。第四级回顾性非对照病例系列。

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