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首页> 外文期刊>Acta Neurochirurgica >Management of spinal infection: a review of the literature
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Management of spinal infection: a review of the literature

机译：脊髓感染管理 - 对文献综述

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Abstract Spinal infection (SI) is defined as an infectious disease affecting the vertebral body, the intervertebral disc, and/or adjacent paraspinal tissue and represents 2–7% of all musculoskeletal infections. There are numerous factors, which may facilitate the development of SI including not only advanced patient age and comorbidities but also spinal surgery. Due to the low specificity of signs, the delay in diagnosis of SI remains an important issue and poor outcome is frequently seen. Diagnosis should always be supported by clinical, laboratory, and imaging findings, magnetic resonance imaging (MRI) remaining the most reliable method. Management of SI depends on the location of the infection (i.e., intraspinal, intervertebral, paraspinal), on the disease progression, and of course on the patient’s general condition, considering age and comorbidities. Conservative treatment mostly is reasonable in early stages with no or minor neurologic deficits and in case of severe comorbidities, which limit surgical options. Nevertheless, solely medical treatment often fails. Therefore, in case of doubt, surgical treatment should be considered. The final result in conservative as well as in surgical treatment always is bony fusion. Furthermore, both options require a concomitant antimicrobial therapy, initially applied intravenously and administered orally thereafter. The optimal duration of antibiotic therapy remains controversial, but should never undercut 6?weeks. Due to a heterogeneous and often comorbid patient population and the wide variety of treatment options, no generally applicable guidelines for SI exist and management remains a challenge. Thus, future prospective randomized trials are necessary to substantiate treatment strategies.
机译：摘要脊柱感染（Si）被定义为影响椎体，椎间盘和/或邻近肩胛骨组织的传染病，占所有肌肉骨骼感染的2-7％。有许多因素，这可能促进Si的发展，包括不仅具有先进的患者年龄和合并症，而且还具有脊髓手术。由于迹象的特异性较低，Si的诊断延迟仍然是一个重要的问题，并且经常看到差的结果。临床，实验室和成像结果应始终支持诊断，磁共振成像（MRI）仍然是最可靠的方法。 Si的管理取决于感染的位置（即脊柱脊柱，椎间，椎间壳），对疾病进展以及考虑年龄和合并症的患者的一般情况。保守治疗大多是在没有或次要神经系统缺陷的早期阶段和严重的合并症的情况下是合理的，这限制了外科选择。尽管如此，药物治疗往往失败。因此，如果有疑问，应考虑外科治疗。保守派和手术治疗的最终结果始终是骨融合。此外，两种选择需要伴随的抗微生物治疗，最初静脉内施用并以后口服给药。抗生素治疗的最佳持续时间仍然存在争议，但永远不会削弱6个？周。由于异质且经常是可混合的患者人口和各种各样的治疗方案，没有任何一般适用的SI指南，管理仍然是一个挑战。因此，未来的预期随机试验是证实治疗策略所必需的。

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