Long-term Outcomes and Effectiveness of Treatment Methods for Vertebral Osteomyelitis With Different Types of Lesions According to the E. Pola Classification
Background. Treatment of vertebral osteomyelitis (VO) is accompanied by a number of organizational and tactical problems related to the multidisciplinary nature of the disease. Therefore, the use of classifications determining treatment tactics is necessary. The evaluation of treatment outcomes and...
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| Format: | Article |
| Language: | Russian |
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Vreden Russian Research Institute of Traumatology and Orthopedics
2023-06-01
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| Series: | Travmatologiâ i Ortopediâ Rossii |
| Subjects: | |
| Online Access: | https://journal.rniito.org/jour/article/viewFile/7445/pdf |
| _version_ | 1797792451107225600 |
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| author | Aleksandr Yu. Bazarov Konstantin S. Sergeev Aleksandra K. Tsvetkova |
| author_facet | Aleksandr Yu. Bazarov Konstantin S. Sergeev Aleksandra K. Tsvetkova |
| author_sort | Aleksandr Yu. Bazarov |
| collection | DOAJ |
| description | Background. Treatment of vertebral osteomyelitis (VO) is accompanied by a number of organizational and tactical problems related to the multidisciplinary nature of the disease. Therefore, the use of classifications determining treatment tactics is necessary. The evaluation of treatment outcomes and efficacy should be conducted in accordance with the classification type of the lesion and decisions made based on the tactical algorithm.
Aim of the study to identify the dependence of long-tenn treatment outcomes of vertebral osteomyelitis on the type of lesion according to the modified Russian version of the E. Pola classification and the methods of treatment used.
Methods. The study analyzed the treatment results of 266 patients with vertebral osteomyelitis from 2006 to 2019. Type A lesions accounted for 24.1% (n = 64), type B 47.0% (n = 125), type C 26.3% (n = 70), and lesions of vertebral processes 2.6% (n = 7). Neurological disorders were detected in 53 observations (type C). Conservative treatment, debridement, and reconstructive surgeries were perfonned. The evaluation of results was carried out a year or more after discharge.
Results. The maximum effectiveness of conservative treatment was noted in uncomplicated courses and minor bone destruction. Conservative treatment of type A lesions led to recovery in 97.4% of cases compared to reconstructive operations (p = 0.002) and recurrences (p = 0.034). Mortality was higher after reconstructive interventions (p = 0.001). The highest number of fatal outcomes after debridement of the focus was observed in type B lesions 15.8% (p = 0.022). Analysis of type C lesions did not reveal significant differences between the methods of treatment used. The maximum number of unsatisfactory results was registered in patients with sepsis: mortality was 17.4%, and in its absence 4.9% (p = 0.039), recurrences 21.7% versus 7.8% (p = 0.043), recovery 56.6% versus 83.5% (p = 0.004), respectively. There were no significant differences in the assessments according to the ODI, NDI, SF-36 scales in the long tenn. The overall survival rate was 84.4%, and the long-tenn one was 90.4%, which increased with conservative treatment compared to reconstructive interventions (p = 0.045).
Conclusion. Conservative treatment and extra-focal fixation of the spine showed maximum effectiveness in low-destructive and uncomplicated lesions (type A). Reconstructive interventions lead to an increase in the number of recurrences and fatal outcomes. Debridement of the focus in septic course of type В lesions leads to an increase in hospital mortality. There were no statistically significant differences between the results of different treatment methods for type C lesions. |
| first_indexed | 2024-03-13T02:33:14Z |
| format | Article |
| id | doaj.art-8a7354ca80044e399ce9246feb8c6b71 |
| institution | Directory Open Access Journal |
| issn | 2311-2905 2542-0933 |
| language | Russian |
| last_indexed | 2024-03-13T02:33:14Z |
| publishDate | 2023-06-01 |
| publisher | Vreden Russian Research Institute of Traumatology and Orthopedics |
| record_format | Article |
| series | Travmatologiâ i Ortopediâ Rossii |
| spelling | doaj.art-8a7354ca80044e399ce9246feb8c6b712023-06-29T11:50:20ZrusVreden Russian Research Institute of Traumatology and OrthopedicsTravmatologiâ i Ortopediâ Rossii2311-29052542-09332023-06-0129271710.17816/2311-2905-74451269Long-term Outcomes and Effectiveness of Treatment Methods for Vertebral Osteomyelitis With Different Types of Lesions According to the E. Pola ClassificationAleksandr Yu. Bazarov0https://orcid.org/0000-0002-5309-4667Konstantin S. Sergeev1https://orcid.org/0000-0002-6621-9449Aleksandra K. Tsvetkova2https://orcid.org/0000-0002-6035-261XTyumen Regional Hospital No 2Tyumen State Medical UniversityTyumen State Medical UniversityBackground. Treatment of vertebral osteomyelitis (VO) is accompanied by a number of organizational and tactical problems related to the multidisciplinary nature of the disease. Therefore, the use of classifications determining treatment tactics is necessary. The evaluation of treatment outcomes and efficacy should be conducted in accordance with the classification type of the lesion and decisions made based on the tactical algorithm. Aim of the study to identify the dependence of long-tenn treatment outcomes of vertebral osteomyelitis on the type of lesion according to the modified Russian version of the E. Pola classification and the methods of treatment used. Methods. The study analyzed the treatment results of 266 patients with vertebral osteomyelitis from 2006 to 2019. Type A lesions accounted for 24.1% (n = 64), type B 47.0% (n = 125), type C 26.3% (n = 70), and lesions of vertebral processes 2.6% (n = 7). Neurological disorders were detected in 53 observations (type C). Conservative treatment, debridement, and reconstructive surgeries were perfonned. The evaluation of results was carried out a year or more after discharge. Results. The maximum effectiveness of conservative treatment was noted in uncomplicated courses and minor bone destruction. Conservative treatment of type A lesions led to recovery in 97.4% of cases compared to reconstructive operations (p = 0.002) and recurrences (p = 0.034). Mortality was higher after reconstructive interventions (p = 0.001). The highest number of fatal outcomes after debridement of the focus was observed in type B lesions 15.8% (p = 0.022). Analysis of type C lesions did not reveal significant differences between the methods of treatment used. The maximum number of unsatisfactory results was registered in patients with sepsis: mortality was 17.4%, and in its absence 4.9% (p = 0.039), recurrences 21.7% versus 7.8% (p = 0.043), recovery 56.6% versus 83.5% (p = 0.004), respectively. There were no significant differences in the assessments according to the ODI, NDI, SF-36 scales in the long tenn. The overall survival rate was 84.4%, and the long-tenn one was 90.4%, which increased with conservative treatment compared to reconstructive interventions (p = 0.045). Conclusion. Conservative treatment and extra-focal fixation of the spine showed maximum effectiveness in low-destructive and uncomplicated lesions (type A). Reconstructive interventions lead to an increase in the number of recurrences and fatal outcomes. Debridement of the focus in septic course of type В lesions leads to an increase in hospital mortality. There were no statistically significant differences between the results of different treatment methods for type C lesions.https://journal.rniito.org/jour/article/viewFile/7445/pdfvertebral osteomyelitisspondylitisspondylodiscitisclassification of vertebral osteomyelitis |
| spellingShingle | Aleksandr Yu. Bazarov Konstantin S. Sergeev Aleksandra K. Tsvetkova Long-term Outcomes and Effectiveness of Treatment Methods for Vertebral Osteomyelitis With Different Types of Lesions According to the E. Pola Classification Travmatologiâ i Ortopediâ Rossii vertebral osteomyelitis spondylitis spondylodiscitis classification of vertebral osteomyelitis |
| title | Long-term Outcomes and Effectiveness of Treatment Methods for Vertebral Osteomyelitis With Different Types of Lesions According to the E. Pola Classification |
| title_full | Long-term Outcomes and Effectiveness of Treatment Methods for Vertebral Osteomyelitis With Different Types of Lesions According to the E. Pola Classification |
| title_fullStr | Long-term Outcomes and Effectiveness of Treatment Methods for Vertebral Osteomyelitis With Different Types of Lesions According to the E. Pola Classification |
| title_full_unstemmed | Long-term Outcomes and Effectiveness of Treatment Methods for Vertebral Osteomyelitis With Different Types of Lesions According to the E. Pola Classification |
| title_short | Long-term Outcomes and Effectiveness of Treatment Methods for Vertebral Osteomyelitis With Different Types of Lesions According to the E. Pola Classification |
| title_sort | long term outcomes and effectiveness of treatment methods for vertebral osteomyelitis with different types of lesions according to the e pola classification |
| topic | vertebral osteomyelitis spondylitis spondylodiscitis classification of vertebral osteomyelitis |
| url | https://journal.rniito.org/jour/article/viewFile/7445/pdf |
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