Percutaneous transpedicular discectomy and drainage in pyogenic spondylodiscitis
Percutaneous transpedicular discectomy and drainage in pyogenic spondylodiscitis
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DOI：
10.1007/s00586-004-0699-z
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发表时间：
2004-12-01
影响因子：
2.8
通讯作者：
Crow, W
中科院分区：
文献类型：
--
作者：
Hadjipavlou, AG;Katonis, PK;Crow, W
无并发症的血源性化脓性脊椎炎的自然病程是自限性愈合。然而，经常发生不同程度的骨质破坏，使脊柱易于发生疼痛性后凸。延迟治疗可能导致严重的神经系统并发症。通过经皮经椎弓根椎间盘切除术对这些感染进行早期清创可以加速愈合的自然过程，并防止进展为骨质破坏和硬膜外脓肿。本文的目的是介绍我们的经皮经椎弓根椎间盘切除术（PTD）的技术，在更严格的患者选择下重新审视这种微创手术技术，并排除广泛椎体破坏伴后凸畸形和硬膜外脓肿、感染性椎间盘突出和椎间孔狭窄引起的神经压迫的病例。在先前发表的28例原发性血源性化脓性脊椎炎患者的报告中，PTD后疼痛的立即缓解率为75%，在长期随访中，成功率为68%。在第二个系列的6例患者中应用更严格的患者选择标准（5例原发性血行性脊柱炎，1例继发性椎板切除术后椎间盘切除术脊柱炎），所有原发性血行性脊柱椎间盘炎患者（5/5）的疼痛立即缓解，并在12-18个月随访时保持持续。然而，对于椎板切除术后感染的患者，该手术不是很有效。这种反应缺乏归因于椎板切除术后的不稳定性。在这一34例患者的联合系列中，手术后即刻成功率为76%。这种技术可以是令人印象深刻的有效和结果持续时，应用于早期阶段的无并发症的脊椎炎和禁忌症的存在不稳定，脊柱后凸的骨质破坏，和神经功能缺损。该手术的特点是微创技术，具有较高的诊断和治疗效果。
The natural history of uncomplicated hematogenous pyogenic spondylodiscitis is self-limiting healing. However, a variable degree of bone destruction frequently occurs, predisposing the spine to painful kyphosis. Delayed treatment may result in serious neurologic complications. Early debridement of these infections by percutaneous transpedicular discectomy can accelerate the natural process of healing and prevent progression to bone destruction and epidural abscess. The purpose of this manuscript is to present our technique of percutaneous transpedicular discectomy (PTD), to revisit this minimally invasive surgical technique with stricter patient selection, and to exclude cases of extensive vertebral body destruction with kyphosis and neurocompression by epidural abscess, infected disc herniation, and foraminal stenosis. In a previously published report of 28 unselected patients with primary hematogenous pyogenic spondylodiscitis, the immediate relief of pain after PTD was 75%, and in the long-term follow-up, the success rate was 68%. Applying stricter patient selection criteria in a second series of six patients (five with primary hematogenous spondylodiscitis and one with secondary postlaminectomy-discectomy spondylodiscitis), all patients with primary hematogenous spondylodiskitis (5/5) experienced immediate relief of pain that remained sustained at 12-18 months follow-up. This procedure was not very effective, however, in the patient who suffered from postlaminectomy infection. This lack of response was attributed to postlaminectomy-discitis instability. The immediate success rate after surgery for unselected patients in this combined series of 34 patients was 76%. This technique can be impressively effective and the results sustained when applied in the early stages of uncomplicated spondylodiscitis and contraindicated in the presence of instability, kyphosis from bone destruction, and neurological deficit. The special point of this procedure is a minimally invasive technique with high diagnostic and therapeutic effectiveness.