Percutaneous lumbar discectomy in the treatment of lumbar discitis.
Percutaneous lumbar discectomy in the treatment of lumbar discitis.
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DOI：
10.1007/bf01358740
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发表时间：
1997-01-01
期刊：
影响因子：
--
通讯作者：
Kramer, J
中科院分区：
文献类型：
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作者：
Haaker, R G;Senkal, M;Kramer, J
腰椎间盘感染是一种严重的并发症，无论是手术椎间盘切除术后还是由其他感染源血行扩散引起的。必须尽快开始特异性抗生素治疗，保守治疗或手术融合才能获得满意的效果。本研究的目的是分析 16 例腰椎间盘感染病例，采用经皮腰椎间盘切除术 (PLD) 治疗，以获得足够量的组织用于组织学检查和微生物培养。 1990年至1994年间，治疗了26名椎骨骨髓炎患者。 16 名患者接受了诊断性 PLD，平均年龄为 41.4 岁（范围为 14-59 岁）。其中 8 例在疾病初期的计算机断层扫描（CT 扫描）和磁共振（MR）图像仅显示出中等程度的变化。另外八例显示邻近受累椎间盘的一个或两个椎体或多或少存在广泛的溶骨性病变。组织学结果显示，9 名患者患有非特异性椎间盘炎，1 名患者患有结核病。对两名患者进行了开放性活检，结果显示非特异性椎间盘炎。微生物分析显示 45% 的患者存在特异性感染。这些患者在抗生素检查后接受了平均 33 天的特定抗生素治疗。只有三名患者接受了手术治疗，包括椎间盘间隙清除和椎间融合；全组都接受了脊柱炎支具。所有患者在最后一次随访中在疼痛、活动度和受累椎间盘间隙自发融合方面均获得了满意的临床结果。总之，PLD是腰椎间盘炎保守治疗中非常有用的微创手术。
Lumbar disc infection, either after surgical discectomy or caused by haematogenous spread from other infection sources, is a severe complication. Specific antibiotic treatment has to be started as soon as possible to obtain satisfactory results in conservative treatment or operative fusion. The aim of this study was to analyse 16 cases of lumbar disc infection, treated with percutaneous lumbar discectomy (PLD) to obtain adequate amounts of tissue for histological examination and microbial culture. Between 1990 and 1994, 26 patients with vertebral osteomyelitis were treated. Sixteen patients, with an average age of 41.4 years (range 14-59 years), underwent a diagnostic PLD. Eight of them showed only moderate changes on computed tomograms (CT scans) and magnetic resonance (MR) images in the initial stages of the disease. The other eight showed more or less extensive osteolytic lesions of one or both vertebral bodies adjacent to the involved disc. The histology results showed non-specific discitis in nine patients and tuberculosis in one. In two patients an open biopsy had been performed, which showed non-specific discitis. Microbiological analysis revealed specific infection in 45% of the patients. These patients received a specific antibiotic treatment after antibiogram for an average of 33 days. Only three patients were treated surgically, with evacuation of the disc space and interbody fusion; the whole group received a spondylitis brace. All patients obtained satisfactory clinical results at the last follow-up regarding pain, mobility and spontaneous fusion of the involved disc space. In conclusion, PLD is a very helpful minimally invasive procedure in conservative treatment of lumbar discitis.