Infectious Lesions of the Spine: Draft National Clinical Guidelines

Мушкин, А. Ю.; Vishnevskiĭ, A A; Peretsmanas, E. O.; Базаров, А. Ю.; Басанкин, И. В.

doi:10.14531/ss2019.4.63-76

Cited by 19 publications

(4 citation statements)

References 36 publications

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“…Однако труднодоступная анатомическая локализация процесса, необходимость вмешательств не только на паравертебральных мягких тканях, но и на межпозвонковых дисках, позвонках, позвоночном канале зачастую ставят перед хирургами непосильные задачи. Наличие сегментарной нестабильности или осложнений в виде неврологического дефицита смещают акцент в сторону ортопедического или нейрохирургического профиля при участии в лечении хирурга-вертебролога из числа ортопедов и/или нейрохирургов [3,9,10].…”

Section: Discussionunclassified

“…Следует отметить, что полноценная диагностика возможна только в учреждениях не ниже III уровня, так как диагноз спондилита считается достоверно установленным при морфологическом подтверждении, достоверно доказанным -только при бактериологическом подтверждении. Для соблюдения указанных критериев должны быть выполнены (минимально): КТ, пункционная или операционная биопсия с исчерпывающим исследованием полученных образцов (культуральный метод -бактериальный посев, цитологическое и/или гистологическое исследование, молекулярно-генетическая диагностика туберкулеза) [10]. Исключение составляют случаи, когда были выполнены санирующие вмешательства в учреждениях I и II уровней по экстренным показаниям с гистологической и микробиологической верификацией диагноза.…”

Section: Discussionunclassified

“…выделенный возбудитель считается основным патогеном [4,12]. К факторам риска относятся сахарный диабет и другие эндокринные заболевания; отдаленные несанированные очаги инфекции; иммунодефицит, чаще приобретенный на фоне ВИЧ-инфекции; парентеральное употребление психостимуляторов; инфекции мочевыделительной системы на фоне нарушения оттока мочи; перенесенные ранее объемные операции, в том числе полостные и спинальные; предшествующее лечение в отделениях реанимации; длительные госпитализации [10,13,14,15].…”

Section: Discussionunclassified

“…При отсутствии клинических, лучевых и лабораторных признаков обострения или осложнений заболевания констатируется выздоровление. При наличии осложнений процесса пациент продолжает лечение у профильных специалистов [10]. При наличии рецидивирующего течения заболевания и осложнений (нестабильность, прогрессирование деструкции, формирование свищей) пациенты проходят лечение в специализированных отделениях стационаров III уровня и федеральных учреждениях по программе оказания ВМП.…”

Section: Discussionunclassified

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Routing and Treatment of Patients with Hematogenous Vertebral Osteomyelitis on the Tyumen Region Example

Базаров¹

2021

Traumatology and Orthopedics of Russia

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Background. Currently, various algorithms of tactical classifications and treatment regimens for hematogenous vertebral osteomyelitis (HVO) are proposed. However, all proposed approaches are designed for the treatment of patients in specialized multidisciplinary clinics departments, although the initial treatment often occurs in municipal polyclinics, private medical centers and district hospitals. The question is what the appropriate scope of diagnostic and therapeutic measures in institutions with different material and resource bases and how to ensure continuity according to the existing three-level system of medical care remains open. The aim of this studyis to determine the probable routing and treatment options for patients with HVO on the example of the Tyumen region, depending on the existing three-level system of providing medical care to the population.Object and Methods.The current Orders of the Ministry of Health of the Russian Federation and the Resolutions of the Government of the Tyumen Region were studied, on which basis a three-level system of providing medical care to the population was organized and organizations providing emergency and elective medical care to patients with HVO were identified. The volume of medical and diagnostic measures in patients with HVO in institutions of various levels, as well as their routing to the regional clinical hospital No. 2 in case of impossibility or inexpediency of providing specialized medical care at the place of primary treatment, is analyzed on the example of the Tyumen region. The clinical material is presented by 267 patients with HVO who were treated in the Tyumen regional clinical hospital No. 2 from 2006 to 2019, 78.7% of whom were treated in the profile of traumatology and orthopedics, 18.7% — neurosurgery and 2.6% — surgery. Results.The list of medical institutions that provide emergency and planned care in traumatology and orthopedics, neurosurgery in the Tyumen region is defined, depending on the level of the institution and the available material and resource base. A block diagram is proposed that determines the scope of medical and diagnostic measures in institutions of I-III levels and specialized departments of multidisciplinary clinical hospitals. The principle of determining the patient profile (surgical, orthopedic, neurosurgical) depending on the type and severity of the inflammatory lesion according to the classification E. Pola (2017) is proposed.Conclusion. The need for effective use of medical and diagnostic resources starting from level I is determined by clear routing of the patient to ensure the continuity of medical care. A full-fledged diagnosis is possible in institutions not lower than the third level with the mandatory determination of the lesion type and the severity of the inflammatory process. HVO treatment is advisable in level III institutions, specialized departments of regional clinical hospitals and federal institutions.

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Routing and Treatment of Patients with Hematogenous Vertebral Osteomyelitis on the Tyumen Region Example

Базаров¹

2021

Traumatology and Orthopedics of Russia

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Is tactical algorithmization possible for infectious lesions of the spine? Literature review

et al. 2020

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Non-specific infectious lesions of the spine present a severe clinical problem due to the high risk of the septic complications and possible mortality. The late diagnosis and subjective treatment options could lead to complicated course of disease, progression of vertebral destruction, development of neurological disorders, as well as multi-resistance of bacteria due to the empiric antibacterial chemotherapy. The modern algorithms of diagnosis and treatment should be aimed at improving the quality of care for patients with infectious spondylitis. A literature review on the current concept of their assessment, including a step-by-step description of the Vertebral Osteomyelitis Guideline Team (VOGT) strategy, and the classifications of Pola (NCPS) and Homagk (SSC) is presented.

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Transpedicular fixation for hematogenous pyogenic vertebral osteomyelitis

Базаров¹

2020

Hir. pozvonoč.

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Objective. To analyze the effectiveness of conservative treatment and extrafocal transpedicular fixation in patients with uncomplicated hematogenous pyogenic vertebral osteomyelitis (PVO).Material and Methods. Ninetyseven medical records of in-patients who were treated for hematogenous PVO in 2007–2017 were analyzed. Among them, men accounted for 73.2 % (n = 71) and women – 26.8 % (n = 26). The acute and subacute forms of the disease were diagnosed in 62 (63.9 %) patients and chronic – in 35 (36.1 %). Type A according to Pola classification totaled 45 patients, type B – 49 and type C – 3. Sixtyfour (66.0 %) patients were treated conservatively, 33 (34.0 %) – using transpedicular fixation and 25 (75.8 %) – using minimally invasive technique. No fixators were placed in the affected vertebrae. All patients underwent antibacterial therapy lasting 6–12 weeks.Results. Good treatment results were obtained in 89 (91.8 %) patients. There were no differences in the severity of pain between the comparison groups before the start of treatment and after one year. However, the pain severity was significantly reduced (p = 0.001) over the time of treatment. Positive results of transpedicular fixation were obtained in 28 (84.8 %) cases, and after three repeated interventions – in 32 (94.1 %), and those of conservative treatment – in 61 (95.3 %) cases. The total number of relapses was 8 (8.2 %), of complications – 3 (3.1 %). The risk of relapse among operated drug addicts was significantly higher (p = 0.033). There were no deaths in the comparison groups, which is explained by the study inclusion and exclusion criteria. All discharged patients were followed-up on an outpatient basis for at least a year, and 72.2 % of them – from 1 year to 8 years.Conclusion. Transpedicular fixation is indicated for uncomplicated hematogenous pyogenic vertebral osteomyelitis, monosegmental lesions and in cases of demands on improved quality of life. The use of such a technique in drug addicts is not recommended.

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Infectious Lesions of the Spine: Draft National Clinical Guidelines

Cited by 19 publications

References 36 publications

Routing and Treatment of Patients with Hematogenous Vertebral Osteomyelitis on the Tyumen Region Example

Routing and Treatment of Patients with Hematogenous Vertebral Osteomyelitis on the Tyumen Region Example

Is tactical algorithmization possible for infectious lesions of the spine? Literature review

Transpedicular fixation for hematogenous pyogenic vertebral osteomyelitis

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