Routing and Treatment of Patients with Hematogenous Vertebral Osteomyelitis on the Tyumen Region Example

Cover Page

Abstract

Background. Currently, various algorithms of tactical classifications and treatment regimens for hematogenous vertebral osteomyelitis (HVO) are proposed. However, all proposed approaches are designed for the treatment of patients in specialized multidisciplinary clinics departments, although the initial treatment often occurs in municipal polyclinics, private medical centers  and  district  hospitals.  The  question  is  what  the  appropriate  scope  of  diagnostic  and  therapeutic  measures  in institutions with different material and resource bases and how to ensure continuity according to the existing three-level system of medical care remains open. The aim of this studyis to determine the probable routing and treatment options for patients with HVO on the example of the Tyumen region, depending on the existing three-level system of providing medical care to the population.

Object and Methods.The current Orders of the Ministry of Health of the Russian Federation and the Resolutions of the Government of the Tyumen Region were studied, on which basis a three-level system of providing medical care to the population was organized and organizations providing emergency and elective medical care to patients with HVO were identified. The volume of medical and diagnostic measures in patients with HVO in institutions of various levels, as well as their routing to the regional clinical hospital No. 2 in case of impossibility or inexpediency of providing specialized medical care at the place of primary treatment, is analyzed on the example of the Tyumen region. The clinical material is presented by 267 patients with HVO who were treated in the Tyumen regional clinical hospital No. 2 from 2006 to 2019, 78.7% of whom were treated in the profile of traumatology and orthopedics, 18.7% — neurosurgery and 2.6% — surgery.

 Results.The list of medical institutions that provide emergency and planned care in traumatology and orthopedics, neurosurgery in the Tyumen region is defined, depending on the level of the institution and the available material and resource base. A block diagram is proposed that determines the scope of medical and diagnostic measures in institutions of I-III levels and specialized departments of multidisciplinary clinical hospitals. The principle of determining the patient profile (surgical, orthopedic, neurosurgical) depending on the type and severity of the inflammatory lesion according to the classification E. Pola (2017) is proposed.

Conclusion. The need for effective use of medical and diagnostic resources starting from level I is determined by clear routing of the patient to ensure the continuity of medical care. A full-fledged diagnosis is possible in institutions not lower than the third level with the mandatory determination of the lesion type and the severity of the inflammatory process. HVO treatment is advisable in level III institutions, specialized departments of regional clinical hospitals and federal institutions.

About the authors

A. Yu. Bazarov

Regional Clinical Hospital No. 2

Author for correspondence.
Email: tyumen_trauma@mail.ru
ORCID iD: 0000-0002-5309-4667

Aleksandr  Yu.  Bazarov —  Cand.  Sci.  (Med.)

Tyumen

Russian Federation

References

  1. Мушкин А.Ю., Вишневский А.А., Перецманас Е.О., Базаров А.Ю., Басанкин И.В. Инфекционные поражения позвоночника: проект национальных клинических рекомендаций // Хирургия позвоночника. 2019. Т. 16. No 4. С. 63–76. DOI: http://dx.doi.org/10.14531/ss2019.4.63-76.
  2. Taylor DG, Buchholz AL, Sure DR, Buell TJ, Nguyen JH, Chen CJ, Diamond JM, Washburn PA, Harrop J, Shaffrey CI, Smith JS. Presentation and outcomes after medical and surgical treatment versus medical treatment alone of spontaneous infec- tious spondylodiscitis: a systematic literature review and meta-analysis. Global Spine J. 2018;8(4 Suppl):49S–58S. doi: 10.1177/2192568218799058.
  3. Pola E, Autore G, Formica VM, Pambianco V, Colangelo D, Cauda R, Fantoni M. New classification for the treatment of pyogenic spondylodiscitis: validation study on a population of 250 patients with a follow-up of 2 years. Eur Spine J. 2017;26(Sup- pl 4):479–488. doi: 10.1007/s00586-017-5043-5.
  4. Bhavan KP, Marschall J, Olsen MA, Fraser VJ, Wright NM, Warren DK. The epidemiology of hematogenus vertebral osteomyelitis: a cohort study in a tertiary care hospital. BMC Infect Dis. 2010;10:158. doi: 10.1186/1471-2334-10-158.
  5. Berbari EF, Kanj SS, Kowalski TJ, Darouiche RO, Widmer AF, Schmitt SK, Hendershot EF, Holtom PD, Huddleston PM, Petermann GW. Executive Sum- mary: 2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults. Clin Infect Dis. 2015;61:859–863. doi: 10.1093/cid/civ633.
  6. Duarte RM, Vaccaro AR. Spinal infection: state of the art and management algorithm. Eur Spine J. 2013;22:2787–2799. doi: 10.1007/s00586-013-2850-1.
  7. Fantoni M et al (2012) Epidemiological and clinical features of pyogenic spondylodiscitis. Eur Rev Med Pharmacol Sci 16(Suppl 2):2–7
  8. Homagk l, Homagk N, Klauss JR, Roehl K, Hofmann GО, Marmelstein D. Spondylodiscitis severity code: scoring system for the classification and treatment of non-specific spondylodiscitis. Eur Spine J. 2016;5:1012–1020. DOI: 10.1007/ s00586-015-3936-8.
  9. Мушкин М.А., Дулаев А.К., Абуков Д.Н., Мушкин А.Ю. Возможно ли тактическое алгоритмирование при инфекционном поражении позвоночника? Обзор литературы // Хирургия позвоночника. 2020. Т. 17. No 2. С. 64–72. DOI: http://dx.doi.org/10.14531/ss2020.2.64-72.
  10. Базаров А.Ю. Классификации неспецифического гематогенного остеомиелита позвоночника. Критический анализ и предложения по применению // Травматология и ортопедия России. 2019. Т. 25. No 1. С. 146–155. doi: 10.21823/2311-2905-2019-25-1-146-155.
  11. Homagk l, Homagk N, Meise HJ, Hofmann GO, Marmelstein D. А spondy- lodiscitis scoring system: SponDT – spondylodiscitis diagnosis and treatment. JSM Spine. 2016;1(1):1004. [Electronic resource]. URL: https://jscimed- central.com/Spine/ spine-1-1004.pdf.
  12. Jeong DK, Lee HW, Kwon YM. Clinical value of procalcitonin in patients with spinal infection. J Korean Neurosurg Soc. 2015;58:271–275. doi: 10.3340/jkns.2015.58.3.271.

Statistics

Views

Abstract: 85

Dimensions

Article Metrics

Metrics Loading ...

PlumX


Copyright (c)



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies