Percutaneous suction and irrigation for the treatment of recalcitrant pyogenic spondylodiscitis.
Percutaneous suction and irrigation for the treatment of recalcitrant pyogenic spondylodiscitis.
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DOI：
10.1186/s10195-018-0496-9
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发表时间：
2018-08-20
期刊：
影响因子：
--
通讯作者：
Mehdian H
中科院分区：
文献类型：
--
作者：
Griffith-Jones W;Nasto LA;Pola E;Stokes OM;Mehdian H
化脓性椎间盘炎的主要治疗是保守的。一旦通过血培养或活检确定了致病微生物，就开始给予适当的静脉注射抗生素。有时患者对抗生素没有反应，需要进行手术冲洗和清创。这些病例的治疗具有挑战性和争议性。此外，许多受影响的患者患有严重的合并症，通常无法进行更广泛的手术干预。本研究的目的是描述一种新型微创经皮技术用于化脓性椎间盘炎椎间盘冲洗和清创术的早期结果。连续 10 名诊断为化脓性椎间盘炎的患者接受了经皮椎间盘冲洗和清创术。该手术是通过将两根 Jamshidi 针经皮插入椎间盘间隙来进行的。手术指征是对抗生素治疗反应不佳（8 名患者）和需要更广泛的活检（2 名患者）。收集术前和术后白细胞计数（WBC）、C反应蛋白（CRP）、红细胞沉降率（ESR）、Oswestry残疾指数（ODI）和背痛视觉模拟评分（VAS）。最短随访时间为 18 个月，并定期进行间隔评估。其中男性 7 名，女性 3 名，平均年龄 67 岁。术前平均白细胞为14.63 × 109/L（10.9-26.4），术后降至7.48 × 109/L（5.6-9.8）。术前平均 CRP 为 188 mg/L (111–250)，术后降至 13.83 mg/L (5–21)。 ESR 也出现了类似的改进。所有患者均报告术后 ODI 和 VAS 评分显着改善。手术后平均住院时间为 8.17 天。所有患者的感染均得到缓解，并且没有与手术相关的并发症。我们的研究证实了我们的经皮技术用于化脓性椎间盘炎冲洗和清创的可行性和安全性。经皮冲洗和抽吸为治疗顽固性脊椎椎间盘炎或用于诊断目的提供了真正的微创选择。所使用的方法与椎间盘造影非常相似，可以轻松适应不同的医院环境。 III 级 本文的在线版本 (10.1186/s10195-018-0496-9) 包含补充材料，可供授权用户使用。
The primary management of pyogenic spondylodiscitis is conservative. Once the causative organism has been identified, by blood culture or biopsy, administration of appropriate intravenous antibiotics is started. Occasionally patients do not respond to antibiotics and surgical irrigation and debridement is needed. The treatment of these cases is challenging and controversial. Furthermore, many affected patients have significant comorbidities often precluding more extensive surgical intervention. The aim of this study is to describe early results of a novel, minimally invasive percutaneous technique for disc irrigation and debridement in pyogenic spondylodiscitis. A series of 10 consecutive patients diagnosed with pyogenic spondylodiscitis received percutaneous disc irrigation and debridement. The procedure was performed by inserting two Jamshidi needles percutaneously into the disc space. Indications for surgery were poor response to antibiotic therapy (8 patients) and the need for more extensive biopsy (2 patients). Pre- and postoperative white blood cell count (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), Oswestry disability index (ODI), and visual analogue score (VAS) for back pain were collected. Minimum follow-up was 18 months, with regular interval assessments. There were 7 males and 3 females with a mean age of 67 years. The mean WBC before surgery was 14.63 × 109/L (10.9–26.4) and dropped to 7.48 × 109/L (5.6–9.8) after surgery. The mean preoperative CRP was 188 mg/L (111–250) and decreased to 13.83 mg/L (5–21) after surgery. Similar improvements were seen with ESR. All patients reported significant improvements in ODI and VAS scores after surgery. The average hospital stay after surgery was 8.17 days. All patients had resolution of the infection, and there were no complications associated with the procedure. Our study confirms the feasibility and safety of our percutaneous technique for irrigation and debridement of pyogenic spondylodiscitis. Percutaneous irrigation and suction offers a truly minimally invasive option for managing recalcitrant spondylodiscitis or for diagnostic purposes. The approach used is very similar to discography and can be easily adapted to different hospital settings. Level III The online version of this article (10.1186/s10195-018-0496-9) contains supplementary material, which is available to authorized users.
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影响因子：
2.8
作者：
Hadjipavlou, AG;Katonis, PK;Crow, W
通讯作者：
Crow, W
DOI：
10.2106/00004623-199706000-00011
发表时间：
1997-06-01
影响因子：
5.3
作者：
Carragee, EJ
通讯作者：
Carragee, EJ
DOI：
10.1016/s1051-0443(96)70871-0
发表时间：
1996-11-01
影响因子：
2.9
作者：
Arya, S;Crow, WN;Walser, E
通讯作者：
Walser, E
影响因子：
5.5
作者：
Fu, Tsai-Sheng;Chen, Lih-Hui;Chen, Wen-Jer
通讯作者：
Chen, Wen-Jer
影响因子：
5.2
作者：
Gouliouris, Theodore;Aliyu, Sani H.;Brown, Nicholas M.
通讯作者：
Brown, Nicholas M.