Postoperative meningitis after spinal surgery: a review of 21 cases from 20,178 patients.
Postoperative meningitis after spinal surgery: a review of 21 cases from 20,178 patients.
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DOI：
10.1186/1471-2334-14-220
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发表时间：
2014-04-23
影响因子：
3.7
通讯作者：
Chen LH
中科院分区：
文献类型：
--
作者：
Lin TY;Chen WJ;Hsieh MK;Lu ML;Tsai TT;Lai PL;Fu TS;Niu CC;Chen LH
术后细菌性脑膜炎是脊柱手术中一种罕见的并发症，被认为是与术中意外硬膜切开有关的并发症。在术后出现发热、颈部僵硬和意识障碍的临床三联征的患者，高度怀疑脑膜炎是必不可少的。诊断或治疗的延误可导致发病和死亡。由于术后脑膜炎的发生率较低，很少有研究报道这一并发症。本研究的目的是报告21例脊柱术后脑膜炎的临床特点、实验室评价、治疗过程和预后。我们回顾性分析了2001年1月至2011年8月间诊断为腰椎术后脑膜炎的21例患者（男性13例，女性8例）。手术时患者的中位年龄为67岁（27至82岁）。我们记录了术前诊断、手术方法、引流量、临床表现、实验室评估、脑脊液检查和感染菌。所有被诊断为术后脑膜炎的患者都接受了至少两周的抗生素治疗。临床结果在至少两年的随访后进行评估。2001年1月至2011年8月，我院共施行脊柱手术20178例，术后发生脑膜炎21例（0.10%）。发热18例（85.7%），颈部僵硬19例（90.5%），意识障碍16例（76.2%）。所有患者都至少有两种典型的三联征。此外，头痛9例（42.9%），局灶性神经功能缺损3例（14.3%），癫痫发作2例（9.5%）。在这个系列中没有死亡率。术后脑膜炎在随访至少2年后对脊柱手术结果无不良影响。摘要术后脑膜炎是腰椎手术后罕见的并发症。脊柱手术后出现发热、颈部僵硬和意识障碍的患者，应高度怀疑是否有脑膜炎。术中意外硬膜切开是最重要的预测因素。早期诊断和适当的抗生素治疗可导致良好的结果。
Postoperative bacterial meningitis is a rare complication of spinal surgery and is considered to be a complication related to intraoperative incidental durotomy. A high index of suspicion for meningitis is essential in patients who have the clinical triad of fever, neck stiffness and consciousness disturbance during the postoperative period. A delay in diagnosis or treatment can lead to morbidity and mortality. Due to the low incidence of postoperative meningitis, very few studies have reported this complication. The purpose of this study was to report the clinical features, laboratory evaluations, treatment course and prognosis of 21 patients with post spinal surgery meningitis. We retrospectively reviewed 21 patients (13 male, 8 female) with the diagnosis of postoperative meningitis after lumbar spinal surgery between January 2001 and Aug 2011. The median age of the patients was 67 years old (range 27 to 82 years) at the time of surgery. We recorded the preoperative diagnosis, operative methods, amount of drainage, clinical manifestations, laboratory evaluations, cerebrospinal fluid study, and infectious organisms. All patients diagnosed with postoperative meningitis received at least two weeks of antibiotic treatment. Clinical outcomes were assessed after at least two years of follow-up. From January 2001 to August 2011, 20,178 spinal operations were performed in our institution, and 21 patients (0.10%) were diagnosed with postoperative meningitis. Eighteen patients (85.7%) had fever, 19 (90.5%) had neck stiffness, and 16 (76.2%) had consciousness disturbance. All patients had at least two of the classic triad. In addition, 9 patients (42.9%) had headache, 3 (14.3%) had focal neurological deficits, and 2 (9.5%) had seizure attacks. There was no mortality in this series. Postoperative meningitis showed no adverse effect on the results of spinal surgery after follow-up for at least two years. Postoperative meningitis is a rare complication after spinal lumbar surgery. A high index of suspicion for meningitis should be maintained in patients with the clinical triad of fever, neck stiffness, and consciousness disturbance after spinal surgery. Intraoperative incidental durotomy is the most important predictor. An early diagnosis and appropriate antibiotic treatment can lead to a good outcome.
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DOI：
10.2106/00004623-198163070-00010
发表时间：
1981-01-01
影响因子：
5.3
作者：
EISMONT, FJ;WIESEL, SW;ROTHMAN, RH
通讯作者：
ROTHMAN, RH
影响因子：
3
作者：
JONES, AAM;STAMBOUGH, JL;BOOTH, RE
通讯作者：
BOOTH, RE
影响因子：
11.8
作者：
Finberg, RW;Moellering, RC;Rybak, MJ
通讯作者：
Rybak, MJ
影响因子：
4.1
作者：
MOMBELLI, G;KLASTERSKY, J;NUBOURGH, Y
通讯作者：
NUBOURGH, Y
影响因子：
4.4
作者：
Sinner, SW;Tunkel, AR
通讯作者：
Tunkel, AR