原发性腰椎间盘炎的手术治疗

Surgical treatment of spontaneous lumbar discitis

目的评估后路一期病灶清除、椎间植骨并内固定治疗原发性腰椎间盘炎的外科疗效。方法回顾性分析2002年2月～2008年5月收治的15例原发性腰椎间盘炎患者,其中L3,4间隙1例、L4,5间隙6例、L5、S1间隙8例。所有患者临床主要表现腰部剧烈疼痛,无法坐立,均无椎间盘手术病史及脊柱封闭或穿刺史,经非手术治疗无效后行后路病灶清除、植骨并内固定术。结果所有患者术后腰部疼痛症状明显缓解,病理结果均提示炎性改变,未见结核性改变,细菌培养均为无菌生长;1例术后9个月发生内固定断裂,其余14例随访6～48个月,平均28个月,感染均无复发,影像学检查示腰椎体序列良好,植骨节段均已骨性融合,无内固定物松动、断裂。结论针对原发性腰椎间盘炎早期病灶彻底清除、椎间植骨并坚强内固定的手术方法疗效满意,并可减少抗生素的应用。

Objective To evaluate the outcome on patients with spontaneous lumbar discitis underwent combined one-stage debridement, intervertebral grafting and internal fixation. Methods From February 2002 to May 2008, 15 patients with spontaneous lumbar discitis were analyzed retrospectively. One case occurred at L3/L4, 6 cases at L4/L5 , 8 cases at L5/S1, The principal clinical manifestations of all the patients were severe low back pain, inability to sit or stand. None of the patients had previous spinal surgery or spinal injection, and their diagnosis were confirmed by histopathology after surgery. After ineffective nonoperative treatment, all the patients were treated by one stage debridement, intervertebral grafting and internal fixation. Resuits Post-operatively, all the patients experienced significant relief of symptoms such as low back pain. Postoperative histo- logical examination of the specimen revealed that inflammation occurred in all the patients, but no evidence of tuberculosis. All the cases were negative in germicuhure. The period of follow-up ranged from 6 to 48 months with a mean time of 28 months. Breakage of internal fixation appeared in 1 case at 9 postoperative months. The others obtained normal sequence, good fusion, and no evidence of recurrence or residual infection were observed. No internal fixation failure exited. Conclusion One stage debridement, intervertebral grafting and internal fixation are effective treatments for spontaneous lumbar diseitis, and can reduce the dose of antibiotic.