Full Endoscopic Discectomy, Debridement, and Drainage for High-Risk Patients with Spondylodiscitis
Full Endoscopic Discectomy, Debridement, and Drainage for High-Risk Patients with Spondylodiscitis
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DOI：
10.1016/j.wneu.2019.02.206
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发表时间：
2019-07-01
影响因子：
2
通讯作者：
Chen, Chien-Min
中科院分区：
文献类型：
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作者：
Lin, Guang-Xun;Kim, Jin-Sung;Chen, Chien-Min
目的：评价全内镜清创引流（FEDD）治疗高危椎间盘炎患者的疗效和临床效果。方法：回顾性分析2015年11月至2017年9月期间在我院接受FEDD治疗的14例患者。所有患者均患有单节段感染性椎间盘炎，是手术的高风险候选者。他们的一般状况根据美国麻醉医师协会分级系统进行评估。查尔森合并症指数用于综合评估合并症状况。结果通过数字评定量表 (NRS) 疼痛评分、Oswestry 残疾指数、改良 Macnab 标准和随访时的放射线图像进行评估。结果：所有 14 名患者在 FEDD 后背痛立即缓解，没有与手术相关的并发症。 14 名患者中有 10 名 (71.5%) 被鉴定出致病细菌。 14 名患者中有一半的美国麻醉医师协会评分 >= 3。平均查尔森合并症指数为 5.1 +/- 1.6 分。与术前8.2±0.9的NRS评分相比，术后1周和12个月的NRS评分分别为3.4±1.1和1.4±1.2。术后观察到 Oswestry 残疾指数显着改善（术前，30.1 +/- 3.9；术后 12 个月，17.6 +/- 6.2；P < 0.05）。根据 Macnab 标准（优秀或良好结果），满意度为 85.7%。 FEDD 后没有患者出现任何明显的后凸畸形。结论：FEDD 可能是感染性椎间盘炎患者广泛开放手术的有效替代方案，尤其是那些手术高风险的患者（患有多种合并症的老年患者和全身状况不佳的患者）。
OBJECTIVE: To evaluate the efficacy and clinical results of full endoscopic debridement and drainage (FEDD) for high-risk patients with spondylodiscitis.METHODS: Fourteen patients who underwent FEDD at our institution between November 2015 and September 2017 were retrospectively reviewed. All patients had single-level infectious spondylodiscitis and were high- risk candidates for surgery. Their general condition was evaluated according to the American Society of Anesthesiologists grading system. The Charlson Comorbidity Index was used for comprehensive assessment of comorbidity status. Outcomes were evaluated by numeric rating scale (NRS) pain score, Oswestry Disability Index, modified Macnab criteria, and radiographic images at follow-up.RESULTS: All 14 patients experienced immediate relief of back pain after FEDD, with no procedure-related complications. The causative bacteria were identified in 10 of the 14 patients (71.5%). Half of the 14 patients had an American Society of Anesthesiologists score of >= 3. The average Charlson Comorbidity Index was 5.1 +/- 1.6 points. Compared with the preoperative NRS score of 8.2 +/- 0.9, the NRS scores at 1 week and 12 months after surgery were 3.4 +/- 1.1 and 1.4 +/- 1.2, respectively. A significant improvement in Oswestry Disability Index was observed after surgery (preoperative, 30.1 +/- 3.9; 12 months postoperatively, 17.6 +/- 6.2; P < 0.05). Satisfaction rate was 85.7% based on the Macnab criteria (excellent or good outcome). None of the patients developed any significant kyphotic deformity after FEDD.CONCLUSIONS: FEDD may be an effective alternative to extensive open surgery in patients with infectious spondylodiscitis, especially those who are high-risk candidates for surgery (elderly patients with multiple comorbidities and patients in poor general condition).