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.
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.
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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,
Kubrakov K.M. – Candidate of Medical Sciences, associate professor of the Chair of Neurology & Neurosurgery, Vitebsk State Order of Peoples’ Friendship Medical University,
Kornilov A.V. – postgraduate of the Chair of Surgery of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University,
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,