Differenzierte operative und konservative Therapie der Spondylitis und Spondylodiscitis

Abstract

In the time from 1980 to 1987 58 patients underwent a conservative or operative treatment of spondylitis and spondylodiscitis according to the individual clinical and radiological features. In early or moderately advanced stages of the disease conservative therapy was performed. Under bedrest and antibacterial or tuberculostatic drug therapy bony fusion of the affected vertebral bodies was achieved in 50% of the pyogenic cases. In tuberculous spondylitis fusion rate was 83%. Persistent septic changes, progressive neurological symptoms and gross vertebral damage are indications for surgery. In those cases removal of the focus and intercorporal spondylodesis was performed. Bony union occurred in every cases. At follow-up examination, 3 years after the onset of therapy on an average, 42 patients had no complaints according to the vertebral column. As the results of our study show spondylitis and spondylodiscitis should according to the clinical and radiological features be lead to a differentiated operative or conservative treatment. Then good clinical results are to be supposed.

Treatment of spondylodiscitis

“…It necessitates several weeks of patient immobilisation followed by several months of brace treatment before firm bony union with the graft can be achieved [3]. In contrast to conservative therapy, the fusion rate increased to 90-100% [3,32]. In cases with multi-segmental involvement and longer fusion spans, however, there are higher rates of complications such as pseudarthrosis and bone graft displacement with subsequent kyphotic deformation [3].…”

Anterior Interbody Grafting and Instrumentation for Advanced Spondylodiscitis

“…Several authors have suggested bed rest and prolonged external bracing rather than placing spinal instrumentation 1,12) . Others have advocated a staged instrumented operation with a period of antibiotics therapy after debridement only surgery 4,17,19) .…”

Anterior Column Reconstruction Using Titanium Ring Cages in Severe Vertebral Osteomyelitis

“…Due to its non-specific character of symptoms and rare incidence vertebral osteomyelitis is often diagnosed with a delay of several weeks or even months [1][2][3][4][5][6][7][8][9][10][11][12][13]. In up to 50% of patients, neurologic deficits are present at the time of diagnosis [3].…”

“…The surgical techniques range from anterior debridement and interbody fusion [1,2,5,[14][15][16][17], posterior debridement with internal fixation [6] to combined single-session or sequential procedures with posterior instrumentation, anterior debridement, and anterior column reconstruction using autologous bone grafts [3, 4, 7-10, 13, 18-23]. Anterior instrumentation in the presence of infection has been reported [21,24,25] but still remains controversial due to the risk of bacterial adherence and biofilm formation on foreign bodies leading to persistent or recurrent infection [4,[26][27][28][29].…”