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Pyogene Spondylodiszitis der Brust- und Lendenwirbelsäule

Eine neue Klassifikation zur Entscheidungsfindung bei der Wahl der operativen Therapie

Pyogenic spondylodiscitis of the thoracic and lumbar spine

A new classification and guide for surgical decision-making

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Zusammenfassung

Pyogene Infektionen der Wirbelsäule sind trotz moderner bildgebender diagnostischer Möglichkeiten immer noch mit einer langen diagnostischen Latenz und hoher Letalität behaftet. Um eine rasche und adäquate Therapie zu gewährleisten ist es wichtig, den Fokus der Spondylodiszitis zu erkennen und zu sanieren. In der Literatur gibt es keine Angaben zur Klassifikation der pyogenen Spondylodiszitis und eine darauf basierende Therapiestrategie.

Zwischen 1994 und 2008 wurden insgesamt 269 Patienten in der Orthopädischen Universitätsklinik Heidelberg aufgrund einer Spondylodiszitis der Brust- und Lendenwirbelsäule behandelt. Von den 269 Patienten wurden 221 operiert. Im Rahmen einer retrospektiven Studie wurden klinische Aspekte und das therapeutische Vorgehen bei Patienten mit einer pyogenen Spondylodiszitis untersucht. Die Ergebnisse unterschiedlicher Therapieoptionen miteinander unter Einbeziehung klinisch-radiologischen Aspekte wurden verglichen. Anhand der Daten konnte eine neue Klassifikation entwickelt werden, die als Grundlage für die therapeutische Entscheidungsfindung genutzt werden kann.

Abstract

Despite modern diagnostic imaging options pyogenic infections of the spine are often detected tardily and therefore accompanied by a high mortality rate. To ensure an efficient and adequate therapy it is necessary to identify and treat the focus of inflammation. The recommendations for the operative strategy are still a highly controversial issue. On the other hand no classification and guidelines for surgical treatment and treatment strategies of pyogenic spinal infection have yet been published.

Pyogenic spinal infections are often underestimated in frequency of occurrence and severity of symptoms. From 1994 until 2008, 269 patients suffering from an infection of the thoracic and lumbar spine were treated in the Department of Orthopedic Surgery Heidelberg and 221 patients underwent surgery. Within the scope of a clinical trial clinical aspects and therapeutic consequences of patients with pyogenic spinal infections were retrospectively investigated. Based on the study data a classification of pyogenic spinal infections of the thoracic and lumbar spine and a guide for surgical decision-making was developed.

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Authors and Affiliations

  1. Department Orthopädie, Unfallchirurgie und Paraplegiologie, Zentrum für Wirbelsäulenchirurgie, Stiftung Orthopädische Universitätsklinik der Ruprecht-Karls-Universität Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland

    M. Akbar, B. Lehner, S. Doustdar, C.H. Fürstenberg, S. Hemmer, C. Carstens & B. Wiedenhöfer

  2. Institut für Medizinische Biometrie und Informatik, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland

    T. Bruckner

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  1. M. Akbar
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  4. C.H. Fürstenberg
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Correspondence to M. Akbar.

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Akbar, M., Lehner, B., Doustdar, S. et al. Pyogene Spondylodiszitis der Brust- und Lendenwirbelsäule. Orthopäde 40, 614–623 (2011). https://doi.org/10.1007/s00132-011-1742-5

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