CONTINUOUS IRRIGATION IN SPINAL INFECTION PLACE OF APPLICATION: A RETROSPECTIVE CLINICAL STUDY

Öz

OBJECTIVE: Demonstration of enhancing the effectiveness of antibiotic irrigation applications in spinal infection cases.MATERIALS AND METHODS: 58 patients were included in the study that is operated for spinal infections between the years 2013-2015 in Ankara Training and Research Hospital and Ankara Numune Education and Research Hospital neurosurgery clinics. The mean age of patients was 46.8. 28 were female, 30 were male. All of the patients were examined after developing infection from simple discectomy. Drains irrigation was applied during 5-7 days for 34 patients who do not benefit from empirical antibiotic therapy. In all postoperative patients, complete blood count, biochemical studies, imaging studies, erythrocyte sedimentation rate ESR , C-reactive protein CRP , microbiological investigations were evaluated. RESULTS: Duration of symptoms emerging after the operation ranged from 7 days to 18 months. The most common symptom was movement restrictions. Wound discharge of 12 patients were available. In 56 of 58 patients ESR, in 36 patients CRP levels were found high. Aaxillary fever values ranged from 37.5 to 39 in 12 patients. Leukocytosis between 10500-22000 / mm3 was present in 34 patients. CONCLUSION: The efficacy of antibiotics can be increased with continuous irrigation in addition to developing abscess drainage of the infected area in patients with spinal infection after discectomy

Anahtar Kelimeler

• spinal infection,irrigation,antibiotic

SPİNAL ENFEKSİYON OLGULARINDA SÜREKLİ İRRİGASYON UYGULAMASININ YERİ: RETROSPEKTİF KLİNİK ÇALIŞMA

Öz

AMAÇ: Spinal enfeksiyon olgularında irrigasyon uygulamasının antibiyotiklerin etkisini arttırdığının gösterilmesi.GEREÇ VE YÖNTEMLER: 2013-2015 yılları arasında Ankara Eğitim ve Araştırma Hastanesi ile Ankara Numune Eğitim ve Araştırma Hastanesi Beyin ve Sinir Cerrahisi Kliniklerinde spinal enfeksiyon tanısıyla tedavi edilmiş yaş ortalaması 46,8 olan 28’i kadın 30’u erkek toplam 58 hasta çalışmaya dahil edilmiştir. İncelenen olguların tümü basit diskektomi sonrası gelişen mesafe enfeksiyonlarıydı. Ampirik antibiyotik tedavisinden fayda görmeyen 34 hastaya loja bırakılan drenler ile 5-7 gün süreyle irrigasyon uygulanmıştır. Tüm hastalarda postoperatif ağrı şikayeti,hemogram ve biyokimyasal çalışmalar,görüntüleme çalışmaları,eritrosit sedimentasyon hızı ESR , c-reaktif protein CRP ile mikrobiyolojik incelemeler değerlendirilmiştir.BULGULAR: Semptomların operasyon sonrası ortaya çıkma süresi 7 gün ile 18 ay arasında değişmekteydi. En sık semptom hareket kısıtlılığıydı.12 hastada yara yerinden akıntı mevcuttu. 58 hastanın 56’sında ESR,36’sında CRP değerleri yüksek bulundu.12 hastada aksiller ateş değeri 37,5 ile 39 arasında değişmekteydi.34 hastada 10500-22000/mm3 arasında lökositoz mevcuttu.SONUÇ:Diskektomi sonrası gelişen spinal enfeksiyon olgularında abse drenajına ek olarak enfekte alanın sürekli yıkanması ile antibiyotik tedavisinin etkinliği arttırılabilir

Anahtar Kelimeler

• Spinal enfeksiyon,irrigasyon,antibiyotik

Kaynakça

1. )Sonntag VKH: History of spinal disorders in: Menezes AH and Sonntag VKH Principles of spinal surgery. Mc Graw-Hill, New York. 1996; 3-23.
2. )Wiltse LL: The history of spinal disorders. Frymoyer JW.(ed): The adult spine. Principles and practice. Lippincot-Raven, Phila- delphia. 1997; PP 3-40.
3. )Marketos SG, Skiadas PK: Galen: A pioneer of spine research. Spine. 1999; 24: 2358-2362.
4. )Albee FH: Transplantation of aportion of the tibia into the spi- ne for Pott'sdisease. JAMA. 1911; 57: 885-886.
5. )Ito H, Tsuchiya J, Asami G: A new radical operation for Pott's disease. JBone Joint Surg. 1934; 16: 499-515.
6. )Müller W: Transpetitoneale freilegung der wirbelsaule bei tu- berculoser spondylitis. Deutsch Zischr. 1906; 85: 128.
7. )Naderi S: İyatrojenik disk aralığı enfeksiyonları, Spinal Enfek- siyonlar, ed: Palaoğlu S. İzmir: Türk Nöroşirürji Derneği Spinal Cerrahi Grubu Yayınları Yayın No 1: 211-214. )Rawlings CE, Wilkins RH: Postpoerative intervertebral disc space infections. In: Wilkins Robert H, Rengachary Setti S ed. Neurosurgery in 3 volumes 2nd edition. McGraw-Hill Company. ; 3825-3830.
8. )Wirtz DC et al: Diagnostic and therapeutic management of- lumbar and thoracic spondylodiscitis. Arch Orthop Trauma Surg. 2000; 120: 245-251.

9. )McCutchen TM, Cuddy BG: Intervertebral disc space infecti- on. Neurosurgery Quarterly. 2001; 11: 209-219.
10. )Onik G, Shang Y, Maroon JC: Automated percutaneousbi- opsy in postoperative discitis: A new method. AJNR. 1990; 11: 393.
11. )Cornett CA, Vincent SA, Crow J, Hewlett A. Bacterial Spi- ne Infections in Adults: Evaluation and Management. J Am Acad Orthop Surg. 2016 Jan;24(1):11-8. doi: 10.5435/JAA- OS-D-13-00102.
12. )Patel NB, Dodd ZH, Voorhies J, Horn EM. Minimally inva- sive lateral transpsoas approach for spinal discitis and osteom- yelitis. J Clin Neurosci. 2015 Nov;22(11):1753-7. doi: 10.1016/j. jocn.2015.03.061. Epub 2015 Jul 22.
13. )Hancı M: Postoperatif lomber spondilodiskit. İstanbul:Logos Yayıncılık, 2002.
14. )Fraser RD, Osti OL, Roberts BV: Discitis followingchemonuc- leolysis- an experimental study. Spine. 1986; 11: 679-687.
15. )Rohde V, Meyer B. Spondylodiscitis after lumbar discectomy. Spine. 1998; 23: 615-620.
16. )Ozuna MR: Delamarter RB. Pyogenic vertebralosteomyeli- tis and postsurgical disc space infections. Orthopedic Clinics of North America. 1996; 27: 87-94.
17. )Dall BE, Dale ER, Odette WG, Batts DH: Postoperativedisci- tis- Diagnosis and management. Clinical Orthopaedics and Re- lated Research. 1987; 224: 138-146.
18. )Malik YM, McCormick P. Management of spine andinterver- tebral disc space infection. Contemp Neurosurg. 1988; 10: 1-6.
19. )Young RF, Lawner PM. Perioperative antibiotic prophy- laxisfor prevention of postoperative neurosurgical infection. J Neurosurg. 1987; 66: 701-705.
20. )Benli IT, Kış M, Akalın S, Şıtak M, Kanevetçi S, Duman E: The results ofanterior radical debridement and anterior instru- mentation in Pott's disease and comparison with other surgical techniques. Kobe J Med Sel. 2000; 46: 39-68.
21. )Carragee EJ. Kim D, van der Vlugt T. Vittum D: The clinical use oferthyrocyte sedimentation rate in pyogenic vertebral osteo- myelitis. Spine. 1997; 22: 2089-93.
22. )Chang CY, Simeone FJ, Nelson SB, Taneja AK, Huang AJ. Is Biopsying the Paravertebral Soft Tissue as Effective as Biopsying the Disk or Vertebral Endplate? 10-Year Retrospective Review of CT-Guided Biopsy of Diskitis-Osteomyelitis.AJR Am J Roentge- nol. 2015 Jul;205(1):123-9. doi: 10.2214/AJR.14.13545.
23. )Chelsom J, Solberg CO: Vertebral osteomyelitis at a Norwe- gian university hospital 1987-1997: clinical features, laboratory findings and outcome. Scand J Infect Dis. 1998; 30: 147-51.
24. )Rezai AR, Lee M, Cooper PR, Errico T, Koslow M: Mo- dern management of spinal tuberculosis. Neurosurgery. ; 36: 87-98. )Fang D, Cheung KM, Dos Remedios ID, Lee YK, Leong JC: Pyogenic vertebral osteomyelitls: treatment by anterior spinal debridement and fusion. J Spinal Disord. 1994; 7: 173-80.
25. )Zileli M: Spinal tüberkülozda klinik yaklaşım ve hasta yöne- timi. Palaoğlu S (ed): Spinal Enfeksiyonlar. TND Spinal Cerrahi Grubu Yayınları, İzmir. 2000; 81-88.