Decompression alone versus fusion for pyogenic spondylodiscitis

Noh, Sung Hyun; Zhang, Ho Yeol; Lim, Hyun Woo; Song, Hyeon Jin; Yang, Kyung Hwa

doi:10.1016/j.spinee.2017.04.015

Cited by 20 publications

(12 citation statements)

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“…Our findings suggest that physicians should be aware of possible PSD in patients who complain about significant back pain and limited range of motion while CRP and/or ESR are elevated, even if leukocytosis or high body temperature is absent [21]. Moreover, the continuous monitor of the CRP and ESR postoperatively until the end of the antibiotic regime could help the physicians determine how the patients respond to the treatment [22,23]. MRI has been widely recognized as the golden standard for imaging of spinal infections [24].…”

Section: Discussionmentioning

confidence: 89%

“…However, when conservative treatments fail or significant symptoms develop, such as significant bone destruction, neurological impairment and spinal instability, surgical intervention should be implemented as soon as possible to eliminate the infection and restore the alignment of the spine (Fig. 3) [23,24,[33][34][35]. For patients who are elderly and predisposed with risk factors Fig.…”

Section: Discussionmentioning

confidence: 99%

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Early surgery with antibiotic medication was effective and efficient in treating pyogenic spondylodiscitis

Guo

Wang

Chen

et al. 2021

BMC Musculoskelet Disord

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Background Pyogenic spondylodiscitis (PSD) is challenging to the orthopedist with regards to diagnosis and treatment. The present study was designed to assess and suggest the most indicative diagnostic method and evaluate the effect of surgery comprising of debridement, instrumentation and fusion in treating PSD. Methods Seventy-six patients with PSD who underwent surgical intervention were retrospectively enrolled. Their medical documents, corrections of spinal alignment and improvements in neurological function were assessed. Surgical approaches were compared in lumbar surgeries regarding the improvements in lordotic angle and neurological function. Results Elevated c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were found in 77.6 and 71.1% patients respectively. Infectious lesions were found at lumbar (85.5%), cervical (10.5%) and thoracic (3.9%), ascertained with contrast-enhanced MRI. For lumbar patients, surgery was performed through the anterior (26.2%), posterior (49.2%) or combined approach (24.6%), and differences in improvement of lordosis and neurological function between each approach were insignificant. The pathogen was identified in 22.4% of the patients. Postoperative antibiotic therapy was managed against the result of susceptibility test, or empirically given to patients with negative cultures. All antibiotic therapy was initiated intravenously for 4–6 weeks and orally for 6 weeks. Conclusion Elevated CRP and/or ESR, with focal hyper-intensity on contrast-enhanced MRI are suggestive of possible PSD. Surgical intervention comprising of debridement, short-segment instrumentation and fusion that early applied to the PSD patients followed by postoperative antibiotic therapy have demonstrated preferable outcomes, but require further study. The translational potential of this article This article advocates early surgery to enable prompt diagnosis and treatment of PSD, and thus guarantee favorable outcomes for patients, as is shown in our study. In addition, different surgical approaches to the lesions were compared and discussed in this manuscript, but no differences in outcome between approaches were found. This suggests that thorough debridement should be prioritized over selection of surgical approach. In summary, this article has large translational potential to be applied clinically.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Early surgery with antibiotic medication was effective and efficient in treating pyogenic spondylodiscitis

Guo

Wang

Chen

et al. 2021

BMC Musculoskelet Disord

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“…The full-text articles for these 56 studies were then reviewed and subjected to our inclusion criteria, after which 48 articles were eligible for systematic review. 3,6-52 (Figure 1) Following an additional search on Cochrane Review, 2 additional studies 53,54 were found, and a total of 50 articles were eligible for final systematic review (Tables 1 and 2) 16 studies reported both surgical and medical outcomes. All but 3 studies were retrospective in nature.…”

Section: Resultsmentioning

confidence: 99%

Presentation and Outcomes After Medical and Surgical Treatment Versus Medical Treatment Alone of Spontaneous Infectious Spondylodiscitis: A Systematic Literature Review and Meta-Analysis

Taylor

Buchholz

Sure

et al. 2018

Global Spine Journal

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Study Design:Systematic literature review.Objectives:The aims of this study were to (1) describe the clinical features, disabilities, and incidence of neurologic deficits of pyogenic spondylodiscitis prior to treatment and (2) compare the functional outcomes between patients who underwent medical treatment alone or in combination with surgery for pyogenic spondylodiscitis.Methods:A systematic literature review was performed using PubMed according to PRISMA guidelines. No year restriction was put in place. Statistical analysis of pooled data, when documented in the original report (ie, number of patients with desired variable and number of patients evaluated), was conducted to determine the most common presenting symptoms, incidence of pre- and postoperative neurologic deficits, associated comorbidities, infectious pathogens, approach for surgery when performed, and duration of hospitalization. Outcomes data, including return to work status, resolution of back pain, and functional recovery were also pooled among all studies and surgery-specific studies alone. Meta-analysis of studies with subgroup analysis of pain-free outcome in surgical and medical patients was performed.Results:Fifty of 1286 studies were included, comprising 4173 patients undergoing either medical treatment alone or in combination with surgery. Back pain was the most common presenting symptom, reported in 91% of patients. Neurologic deficit was noted in 31% of patients. Staphylococcus aureus was the most commonly reported pathogen, seen in 35% of reported cases. Decompression and fusion was the most commonly reported surgical procedure, performed in 80% of the surgically treated patients. Combined anterior-posterior procedures and staged surgeries were performed in 33% and 26% of surgeries, respectively. The meta-analysis comparing visual analog scale score at follow-up was superior among patients receiving surgery over medical treatment alone (mean difference −0.61, CI −0.90 to −0.25), while meta-analysis comparing freedom from pain in patients receiving medical treatment alone versus combined medical and surgical treatment demonstrated superior pain-free outcomes among surgical series (odds ratio 5.35, CI 2.27-12.60, P < .001), but was subject to heterogeneity among studies (I 2 = 56%, P = .13). Among all patients, freedom from pain was achieved in 79% of patients, and an excellent outcome was achieved in 73% of patients.Conclusion:Medical management remains first-line treatment of infectious pyogenic spondylodiscitis. Surgery may be indicated for progressive pain, persistent infection on imaging, deformity or neurologic deficits. If surgery is required, reported literature shows potential for significant pain reduction, improved neurologic function and a high number of patients returning to a normal functional/work status.

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“…These patients are recommended to take a long-term rest and use spinal corsets to prevent spinal deformities which may occur in the chronic period. It has been reported that the treatment outcome is better when the surgical treatment is simple and less invasive (1,(5)(6)(7). S. aureus, M.…”

Section: Materialmentioning

confidence: 99%

İyatrojenik Lumbar Spondilodiskitlerde Ekonomik Maliyet, Tanısal ve Prognostik Belirteçler

Yüksel

Öğden

Akkaya

et al. 2020

Kırıkkale Üniversitesi Tıp Fakültesi Dergisi

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In this study, the economic cost, diagnostic and prognostic laboratory markers of lumbar spondylodiscitis, which emerged as a complication after surgical intervention in the lumbar region, were investigated. Material and Methods: Age and gender of the patients were recorded. Furthermore, surgical intervention type (spinal instrumentation, lumbar discectomy), biopsy results of infected tissue, concomitant morbidities, duration of hospital stay and microorganism growth in culture materials were evaluated in patients. In addition, values of serum C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), leukocyte, neutrophil and lymphocyte count which were obtained from these patients at admission to hospital and at discharge from hospital were recorded. Moreover, treatment costs of these patients were examined. Results: Nine patients (women=7, men=2) with a mean age of 58±14.92 years were included in this study. All parameters of patients were not different in terms of surgical intervention type. However, when the patients were discharged from the hospital, their ESR and neutrophil counts decreased and lymphocyte count increased in all of them. Although CRP level values decreased as numerical value at discharge, this decrease was not statistically significant. Correlation analysis showed that length of hospital stay and tissue biopsy performed to the patients increased the economic cost. Conclusion:It was concluded that any routine laboratory parameter investigated in this study could not be a valid biomarker for diagnosis and follow-up of spondylodiscitis that emerged after surgical intervention. On the other hand, it was concluded that diagnosis and treatment of this disease, whose prevalence is increasing, may have a high economic cost for patients and countries.

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Decompression alone versus fusion for pyogenic spondylodiscitis

Cited by 20 publications

References 5 publications

Early surgery with antibiotic medication was effective and efficient in treating pyogenic spondylodiscitis

Early surgery with antibiotic medication was effective and efficient in treating pyogenic spondylodiscitis

Presentation and Outcomes After Medical and Surgical Treatment Versus Medical Treatment Alone of Spontaneous Infectious Spondylodiscitis: A Systematic Literature Review and Meta-Analysis

İyatrojenik Lumbar Spondilodiskitlerde Ekonomik Maliyet, Tanısal ve Prognostik Belirteçler

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