DOI: https://doi.org/10.22263/2312-4156.2019.5.59
Petukhov V.I., Kubrakov K.M., Kornilov A.V., Kuncevicz M.V.
The evaluation of the efficacy of the algorithm used for treatment of patients with nonspecific pyo-inflammatory diseases of the spine
Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
Vestnik VGMU. 2019;18(5):59-68.
Abstract.
Objectives. To develop an algorithm for the treatment of patients with nonspecific pyo-inflammatory diseases of the spine, depending on the extent of the purulent process and to evaluate its efficacy.
Material and methods. The evaluation of the developed algorithm efficacy was carried out according to the number of repeated hospitalizations and the bed-day of patients withnon specific pyo-inflammatory diseases of the spine (NPDS). The retrospective group included 28 patients who had undergone treatment at the bases of purulent surgery and neurosurgery of the Vitebsk Regional Clinical Hospital before the introduction of the algorithm; the prospective group consisted of 46 patients who were receiving treatment at the thoracic purulent surgical department in accordance with the developed algorithm.
In patients of the prospective group, the modified Frankel scale was used to evaluate the evolution of neurological disorders, and the visual analogue pain scale (VAS) was made use of to assess the pain syndrome. The evaluation of the neurological status was carried out on admission, on discharge from the hospital and during the control hospitalization in 1-2 months.
Results. We observed a significant decrease in pain intensity: 8 [7-9] points on admission, 1.5 [1-3] on discharge from the hospital and 0 [0-2] points on the follow-up examination (РWilcoxon<0.001). There was a statistically significant regression of neurological deficit (РWilcoxon<0.001), with a transition of 100% of survivors from Frankelm A class, 100% from Frankelm B, 100% from Frankelm C and 78.5% from Frankelm D class to higher classes.
The introduction of the developed algorithm for the treatment of patients with NPDS into practice allowed to decrease the number of repeated hospitalizations of patients from 25.9% to 4.3% (p=0.049), to reduce the average hospital bed-day from 55.18±7.64 to 38.50±2.90 days (p = 0.028) and to cut treatment costs by 41581.89 BYN / year.
Conclusions. The application of the developed algorithm for the treatment of patients with NPDS to practice enables the significant reduction of pain and neurological deficit regression, as well as the decrease in the number of relapses and repeated hospitalizations, which in its turn cuts the treatment costs.
Key words: spinal osteomyelitis, spondylodiscitis, spinal epidural abscess, treatment algorithm, neurological disorders.
References
1. Goncharov MYu, Sakovich VP. Assessment of the evolution of neurological disorders as a sign of treatment effectiveness in patients with non-specific purulent spinal diseases. Sarat Nauch-med Zhurn. 2012:8(2):420-4. (In Russ.)
2. Goncharov MYu, Levchik EYu. Systemic inflammatory response syndrome in the surgical treatment of non-specific purulent spinal diseases. Biul VSNTs SO RAMN. 2012;(4):39-42. (In Russ.)
3. Karpov IA, Gorbich YuL, Solovey NV, Raznitsyna OT. Overview of the Clinical Recommendations of the American Society for Infectious Diseases (IDSA) for the diagnosis and treatment of adult spondylitis. Klin Mikrobiologiia Antimikrob Khimioterapiia. 2017;19(3):181-98. (In Russ.)
4. Fraerman AP, Perl'mutter OA, Shakhov AV, Parfenov VE, Shulev YuA, Orlov VP; Fraerman AP, red. Purulent Neurosurgery: ruk dlia vrachei. Nizhny Novgorod, RF: Povolzh'e; 2016. 128 р. (In Russ.)
5. Ardashev IP, Gatin VR, Ardasheva EI, Starikov TN, Noskov VP, Long-term results of conservative treatment of osteomyelitis of the spine. Vestn Novykh Med Tekhnologii. 2014;2(3):108-11. (In Russ.)
6. Khafizova IF, Popova NA, Panyukhov AG, Gumerov FR. Spondylodiscitis: early diagnosis and treatment tactics. Kazan Med Zhurn. 2016;97(6):988-93. (In Russ.)
7. Manoso MW, Cizik AM, Bransford RJ, Bellabarba C, Chapman J, Lee MJ. Medicaid status is associated with higher surgical site infection rates after spine surgery. Spine (Phila Pa 1976). 2014 Sep;39(20):1707-13. doi: http://dx.doi.org/10.1097/BRS.0000000000000496
8. Vissarionov SV, Baindurashvili AG, Kryukova IA. International Classification Standards for Spinal Cord Injury (ASIA / ISNCSCI Scale, 2015 Revision). Ortopediia Travmatologiia Vosstanov Khirurgiia Det Vozrasta. 2016;4(2):67-72. (In Russ.)
9. Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, J, et al. International standards for neurological classification of spinal cord injury. J Spinal Cord Med. 2011 Nov;34(6):535-46. doi: http://dx.doi.org/10.1179/204577211X13207446293695
10. Roberts TT, Leonard GR, Cepela DJ. Classifications In Brief: American Spinal Injury Association (ASIA) Impairment Scale. Clin Orthop Relat Res. 2017 May;475(5):1499-1504. doi: http://dx.doi.org/10.1007/s11999-016-5133-4
11. Sobottke R, Seifert H, Fätkenheuer G, Schmidt M, Gossmann A, Eysel P. Current Diagnosis and Treatment of Spondylodiscitis. Dtsch Arztebl Int. 2008 Mar;105(10):181-7. doi: http://dx.doi.org/10.3238/arztebl.2008.0181
12. Segreto FA, Beyer GA, Grieco P, Horn SR, Bortz CA, Jalai CM, et al. Vertebral osteomyelitis: A comparison of associated outcomes in early versus delayed surgical treatment. Int J Spine Surg. 2018 Dec 21;12(6):703-712. doi: http://dx.doi.org/10.14444/5088
13. Petukhov VI, Semenov VM, Kornilov AV, Kubrakov KM. Surgical treatment of complicated forms of nonspecific spondylodiscitis. Khirurgiia Vostoch Evropa. 2018;7(4):426-35. (In Russ.)
14. Kubrakov KM, Petukhov VI, Kornilov AV. Vacuum therapy application in surgical treatment of spinal epidural abscesses. Novosti Khirurgii. 2019;27(1):59-65.
15. Shakhray SV, Sokolov AYu, Gain MYu. Evaluation of the economic efficiency of the Minsk city center of outpatient and minimally invasive surgery. Novosti Khirurgii. 2011;19(6):76-81. (In Russ.)
Information about authors:
Petukhov V.I. – Doctor of Medical Sciences, associate professor, head of the Chair of Surgery of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University,
ORCID: https://orcid.org/0000-0002-4042-3978
Kubrakov K.M. – Candidate of Medical Sciences, associate professor of the Chair of Neurology & Neurosurgery, Vitebsk State Order of Peoples’ Friendship Medical University,
ORCID: https://orcid.org/0000-0001-6723-0589
Kornilov A.V. – postgraduate of the Chair of Surgery of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University,
ORCID: https://orcid.org/0000-0001-8709-6639
Kuncevicz M.V. – postgraduate of the Chair of Hospital Surgery with the courses of Urology & Pediatric Surgery, Vitebsk State Order of Peoples’ Friendship Medical University,
ORCID: https://orcid.org/0000-0002-8122-6655
Correspondence address: Republic of Belarus, 210009, Vitebsk, 27 Frunze ave., Vitebsk State Order of Peoples’ Friendship Medical University, Chair of Neurology & Neurosurgery. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Konstantin M. Kubrakov.
