ТРАНСПЕДИКУЛЯРНАЯ ФИКСАЦИЯ ПРИ ГЕМАТОГЕННОМ ОСТЕОМИЕЛИТЕ ПОЗВОНОЧНИКА

Objective . To analyze the effectiveness of conservative treatment and extrafocal transpedicular fixation in patients with uncomplicated hematogenous pyogenic vertebral osteomyelitis (PVO). Material and Methods . Ninetyseven medical records of in-patients who were treated for hematogenous PVO in 2007–2017 were analyzed.  Among them, men accounted for 73.2 % (n = 71) and women – 26.8 % (n = 26). The acute and subacute forms of the disease were diagnosed in 62 (63.9 %) patients and chronic – in 35 (36.1 %). Type A according to Pola classification totaled 45 patients, type B – 49 and type C – 3.  Sixtyfour (66.0 %) patients were treated conservatively, 33 (34.0 %) – using transpedicular fixation and 25 (75.8 %) – using minimally invasive technique. No fixators were placed in the affected vertebrae. All patients underwent antibacterial therapy lasting 6–12 weeks. Results . Good treatment results were obtained in 89 (91.8 %) patients. There were no differences in the severity of pain between the comparison groups before the start of treatment and after one year. However, the pain severity was significantly reduced (p = 0.001) over the time of treatment. Positive results of transpedicular fixation were obtained in 28 (84.8 %) cases, and after three repeated interventions – in 32 (94.1 %), and those of conservative treatment – in 61 (95.3 %) cases. The total number of relapses was 8 (8.2 %), of complications –  3 (3.1 %). The risk of relapse among operated drug addicts was significantly higher (p = 0.033). There were no deaths in the comparison groups, which is explained by the study inclusion and exclusion criteria. All discharged patients were followed-up on an outpatient basis for at least a year, and 72.2 % of them – from 1 year to 8 years. Conclusion . Transpedicular fixation is indicated for uncomplicated hematogenous pyogenic vertebral osteomyelitis, monosegmental lesions and in cases of demands on improved quality of life. The use of such a technique in drug addicts is not recommended.