.: ORİJİNAL ARAŞTIRMA
Spondilodiskitiste Cerrahi Tedavi ve Epidemiyolojik Veriler: Klinik Çalışma
Surgical Treatment and Epidemiological Data in Spondylodiscitis: Clinical Study
Turkiye Klinikleri J Med Sci. 2023;43(4):333-42
doi: 10.5336/medsci.2023-99968
Makale Dili: TR
Tam Metin
ÖZET
Amaç: Spondilodiskitis, her ne kadar nadir görülen bir omurga sorunu olsa da yüksek morbiditeye sahip, uzun ve ekonomik açıdan yüksek sağlık harcamalarına neden olan özellikle cerrahi tedavide tam kabul görmüş algoritmaları olmayan ciddi bir omurga-omurilik hastalığıdır. Spondilodiskitis; diskit, osteomyelit, epidural apse, menenjit, subdural ampiyem ve spinal kord apsesini içeren bir spektruma sahiptir. Konservatif tedavi doğru alınan mikrobiyolojik örnekleme sonrası uygun antibiyoterapinin verilmesi, hastanın immobilizasyonu, klinik ve radyolojik açıdan omurganın yapısının yakın izlenmesi şeklindedir. Minimal invaziv işlemlerle örneklemenin yapılamadığı, klinik açıdan ciddi ağrı ve/veya nörolojik defisit varlığında, apse formasyonu oluştuğunda, omurgada deformatik değişiklikler varlığında cerrahi tedavi gerekli hâle gelir. Bu çalışmada, cerrahi tecrübelerimizi ve yaklaşımlarımızı bildirerek literatüre katkı sağlamanın yanında hastalığın kendi popülasyonumuzdaki sıklığı, morbiditesi, enfektif ajanın tespiti, prognozu gibi epidemiyolojik verilerin elde edilmesini sağlaması amaçlanmıştır. Gereç ve Yöntemler: 2012-2022 yılları arasında kliniğimizde spondilodiskitis tanısı alıp tedavi uygulanan 52 erişkin hastanın klinik ve radyolojik özellikleri, laboratuvar bulguları, yapılan tedaviler çalışmaya dâhil edilmiştir. Bulgular: On dört (%26) hastanın yapılan açık cerrahi ile örneklemesinde patojen bakteri tespit edilememekle beraber alınan patoloji incelemeleri iltihabi granülasyon dokusu ile uyumlu gelen hastalardı. Diğer grupta 10 Mycobacterium tuberculosis, 6 Brucella, 1 Candida glabrata üremesi oldu. Yirmi bir hasta piyojenik spondilodiskitli hastalardı. Piyojenik spondilodiskitli hastaların 8'i Staphylococcus aureus, diğer 13 hastada etkenler Staphylococcus epidermidis, Staphylococcus hominis, Escherichia coli, Pseudomonas, Acinetobacter'dir. Sonuç: Spondilodiskitis, multidisipliner yönetimi olan, hastaya göre değişen cerrahi yaklaşımları gerektiren uzun süreli ve yüksek sağlık maliyeti olan bir hastalıktır.
Anahtar Kelimeler: Diskitis; omurga; sinir cerrahisi yöntemleri
Amaç: Spondilodiskitis, her ne kadar nadir görülen bir omurga sorunu olsa da yüksek morbiditeye sahip, uzun ve ekonomik açıdan yüksek sağlık harcamalarına neden olan özellikle cerrahi tedavide tam kabul görmüş algoritmaları olmayan ciddi bir omurga-omurilik hastalığıdır. Spondilodiskitis; diskit, osteomyelit, epidural apse, menenjit, subdural ampiyem ve spinal kord apsesini içeren bir spektruma sahiptir. Konservatif tedavi doğru alınan mikrobiyolojik örnekleme sonrası uygun antibiyoterapinin verilmesi, hastanın immobilizasyonu, klinik ve radyolojik açıdan omurganın yapısının yakın izlenmesi şeklindedir. Minimal invaziv işlemlerle örneklemenin yapılamadığı, klinik açıdan ciddi ağrı ve/veya nörolojik defisit varlığında, apse formasyonu oluştuğunda, omurgada deformatik değişiklikler varlığında cerrahi tedavi gerekli hâle gelir. Bu çalışmada, cerrahi tecrübelerimizi ve yaklaşımlarımızı bildirerek literatüre katkı sağlamanın yanında hastalığın kendi popülasyonumuzdaki sıklığı, morbiditesi, enfektif ajanın tespiti, prognozu gibi epidemiyolojik verilerin elde edilmesini sağlaması amaçlanmıştır. Gereç ve Yöntemler: 2012-2022 yılları arasında kliniğimizde spondilodiskitis tanısı alıp tedavi uygulanan 52 erişkin hastanın klinik ve radyolojik özellikleri, laboratuvar bulguları, yapılan tedaviler çalışmaya dâhil edilmiştir. Bulgular: On dört (%26) hastanın yapılan açık cerrahi ile örneklemesinde patojen bakteri tespit edilememekle beraber alınan patoloji incelemeleri iltihabi granülasyon dokusu ile uyumlu gelen hastalardı. Diğer grupta 10 Mycobacterium tuberculosis, 6 Brucella, 1 Candida glabrata üremesi oldu. Yirmi bir hasta piyojenik spondilodiskitli hastalardı. Piyojenik spondilodiskitli hastaların 8'i Staphylococcus aureus, diğer 13 hastada etkenler Staphylococcus epidermidis, Staphylococcus hominis, Escherichia coli, Pseudomonas, Acinetobacter'dir. Sonuç: Spondilodiskitis, multidisipliner yönetimi olan, hastaya göre değişen cerrahi yaklaşımları gerektiren uzun süreli ve yüksek sağlık maliyeti olan bir hastalıktır.
Anahtar Kelimeler: Diskitis; omurga; sinir cerrahisi yöntemleri
ABSTRACT
Objective: Although spondylodiscitis is a rare spinal problem, it is a serious spinal-spinal disease with high morbidity, long and economically high health expenditures, especially in surgical treatment, which does not have fully accepted algorithms. Spondylodiscitis; It has a spectrum that includes discitis, osteomyelitis, epidural abscess, meningitis, subdural empyema, and spinal cord abscess. Conservative treatment consists of administering appropriate antibiotic therapy after correct microbiological sampling, immobilization of the patient, and close monitoring of the structure of the spine in clinical and radiological terms. Surgical treatment becomes necessary in the presence of clinically severe pain and/or neurologic deficit, in the presence of abscess formation, in the presence of deformative changes in the spine, where sampling cannot be performed with minimally invasive procedures. In this study, it is aimed to contribute to the literature by reporting our surgical experience and approaches, as well as to provide epidemiological data such as the frequency of the disease in our population, morbidity, detection of the infective agent, and prognosis. Material and Methods: The clinical and radiological features, laboratory findings, and treatments of 52 adult patients diagnosed with spondylodiscitis and treated in our clinic between 2012-2022 were included in the study. Results: Although pathogenic bacteria could not be detected in the open surgery sampling of 14 patients (26%), the pathology examinations were found to be compatible with inflammatory granulation tissue. In the other group, there were 10 Mycobacterium tuberculosis, 6 Brucella, 1 Candida glabrata growth. 21 patients were patients with pyogenic spondylodiscitis. Eight of the patients with pyogenic spondylodiscitis were Staphylococcus aureus, and the other 13 patients had Staphylococcus epidermidis, Staphylococcus hominis, Escherichia coli, Pseudomonas, Acinetobacter. Conclusion: Spondylodiscitis is a disease with a long-term and high health cost that requires multidisciplinary management and surgical approaches that vary according to the patient.
Keywords: Diskitis; spine; neurosurgical procudures
Objective: Although spondylodiscitis is a rare spinal problem, it is a serious spinal-spinal disease with high morbidity, long and economically high health expenditures, especially in surgical treatment, which does not have fully accepted algorithms. Spondylodiscitis; It has a spectrum that includes discitis, osteomyelitis, epidural abscess, meningitis, subdural empyema, and spinal cord abscess. Conservative treatment consists of administering appropriate antibiotic therapy after correct microbiological sampling, immobilization of the patient, and close monitoring of the structure of the spine in clinical and radiological terms. Surgical treatment becomes necessary in the presence of clinically severe pain and/or neurologic deficit, in the presence of abscess formation, in the presence of deformative changes in the spine, where sampling cannot be performed with minimally invasive procedures. In this study, it is aimed to contribute to the literature by reporting our surgical experience and approaches, as well as to provide epidemiological data such as the frequency of the disease in our population, morbidity, detection of the infective agent, and prognosis. Material and Methods: The clinical and radiological features, laboratory findings, and treatments of 52 adult patients diagnosed with spondylodiscitis and treated in our clinic between 2012-2022 were included in the study. Results: Although pathogenic bacteria could not be detected in the open surgery sampling of 14 patients (26%), the pathology examinations were found to be compatible with inflammatory granulation tissue. In the other group, there were 10 Mycobacterium tuberculosis, 6 Brucella, 1 Candida glabrata growth. 21 patients were patients with pyogenic spondylodiscitis. Eight of the patients with pyogenic spondylodiscitis were Staphylococcus aureus, and the other 13 patients had Staphylococcus epidermidis, Staphylococcus hominis, Escherichia coli, Pseudomonas, Acinetobacter. Conclusion: Spondylodiscitis is a disease with a long-term and high health cost that requires multidisciplinary management and surgical approaches that vary according to the patient.
Keywords: Diskitis; spine; neurosurgical procudures
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