Causes and preventive strategies of pyogenic spondylitis after percutaneous kyphoplasty

English Keywords:Percutaneous kyphoplasty  Pyogenic spondylitis  Prevention strategy  Cause analysis

English Abstract:

  【Abstract】 Objectives: To explore the causes and prevention strategies of pyogenic spondylitis after percutaneous kyphoplasty(PKP). Methods: The data of 1065 patients with painful osteoporotic vertebral compression fractures(POVCF) received PKP treatment in the Department of Orthopaedics, The Affiliated Hospital of Southwest Medical Universityt from June 2013 to September 2018 were retrospectively reviewed. There were 217 males and 848 females, with an average age of 70.4±6.8 years(56-93 years). Patients in group A(n=332) received PKP directly without strict searching of infection foci before operation. Patients in group B(n=733) received effective anti-infective therapy before PKP for patients with one or more elevated infection indexes of the white blood cell count(WBC), erythrocyte sedimentation rate(ESR), C-reactive protein(CRP), procalcitonin(PCT) before operation. The age, body mass index(BMI), BMD(T value), visual analog scale(VAS) and follow-up time of the two groups were recorded and compared. Preoperative WBC, ESR, CRP, PCT, MRI, magnetic resonance imaging(MRI) of the whole spine, bone scan of the whole body, thoracic and/or lumbar spine anteroposterior X-ray were analyzed respectively. Previous medical records were reviewed and compared between the two groups of patients with potential infectionfoci before operation. Symptoms, signs, laboratory tests and spinal MRI were observed and compared between the two groups of patients with responsible vertebral pyogenic spondylitis after PKP. Results: There was no significant difference in age, BMI, BMD, VAS score, number of cases with increased preoperative infection index and follow-up time between the two groups(P>0.05). In group A, there were 236 patients with one or more elevated infection indicators of POVCF were not treated with antibioticsand there were 2 cases of responsible vertebral pyogenic spondylitis after PKP, all of whom were elderly patients. After failure of antibiotics treatment, the 2 cases received revision operation. Among them, 1 case was complicated with hypertension and urinary tract infection before operation, and died after revision operation; 1 case was complicated with hypertension, diabetes and Parkinson′s disease before operation, which was cured after revision surgery. These 2 patients were all elderly patients. In group B, there were 514 patients with one or more elevated infection indicators, and PKP was performed after effective anti-infection treatment with oral or intravenous antibiotics, 1 case with postoperative symptoms worsen, combined with preoperative laboratory examination results and the image data, consider to preoperative pyogenic spondylitis misdiagnosed as POVCF and accept PKP, and was cured after revision operation. Among the patients with abnormal preoperative infection indicators in group A, 18 cases of urinary tract infection, 24 cases of pulmonary infection, 1 case of skin and soft tissue infection, and 2 cases of prostatitis were found by searching for potential infection foci, which were not treated. In group B, 37 cases of urinary tract infection, 60 cases of pulmonary infection, 3 cases of skin and soft tissue infection, 5 cases of prostatitis, and 7 cases of chronic calculous cholecystitis were found, and all of which were operated after the control of latent infection foci. The infection foci of group B were better controlled than group A, with statistically significant differences(P＜0.05). Conclusions: The main reasons for the responsible vertebral pyogenic spondylitis after PKP include the existed and potential infection in the body without effectively controlling and misdiagnosed the responsible vertebral infectious foci as POVCF before operation. The predisposing factors include old age, diabetes, chronic hepatic, and renal insufficiency and so on. The use of antibiotics before operation can effectively control the existing or potential infectious foci and may reduce the incidence of responsible vertebral infection.