Early Diagnosis and Operative Management in Non Tuberculous Spondylodiscitis: Outcome in a Case Series of 34 Patients

Abstract

Introduction With the high prevalence of tuberculous spondylodiscitis in India and the tendency to label all spondylodiscitis astuberculous, it is prudent to have a high index of suspicion for non tuberculous infections and treat them accordingly. With the concern on the usage of metal implants in the infected spine, we study the safety and efficacy of debridement and stabilization with metal implants in infective spondylodiscitis. Material and Methods Patient records and radiographs of 34 patients of non tuberculous spondylodiscitis who were operated between 2003 and 2013, were reviewed. All the patients were managed with debridement of the infected segment, reconstruction and stabilization of the spine using titanium pedicle screws with interbody spacers. Clinico-radiological follow up was done at 1, 3, 6 and then yearly thereafter. Results 34 patients (M:23, F:11) with an average age of 48 years (20–68yrs)operated between 2003 and 2013. Low back pain with left radiculopathy for an average duration of 4 months (1–12months) was the most common presentation. Neurological involvement was seen in 12 patients (Foot drop- 8, Paraparesis-2 and Sensory deficits - 2). The pathology was monosegmental in 27 patients (L5-S1:10, L4–5:13, L3–4:2, L2–3:2). The infection was hematogenous in 18, post surgery (discectomy/laminectomy) in 15 and post UTI in 1 patient. The surgical isolates were mainly Staphylococcus aureus-17, E.coli and Gram negative bacilli-7, MRSA-5, Pseudomonas-1 and Fungal-4. 28 patients underwent posterior procedure, 1 anterior alone and 5 underwent combined anterior and posterior procedures. All the patients had appropriate antimicrobial therapy and mobilized as early as tolerated. All patients had excellent to good functional results and no evidence of infection at average follow-up of 72 months (27–130 months). ODI and Kirkaldy-Willis criteria showed significant improvement of function postoperatively. All the blood parameters were normalized in 3 months. 1 patient had dural tear which was repaired peroperatively without sequelae, 2 cases required wound exploration and lavage. No other major complications were encountered. All cases showed radiological fusion and no evidence of metal related complications at the latest followup. Conclusion Thorough debridement of necrotic material creates a good vascularised environment and restoring stability compromised by either infection or prior surgery helps in healing process and reduces morbidity of patients, with early return to normal activity. The use of metal implants is safe and efficacious even in the presence of infection.

Independent Reliability Analysis of a New Classification for Pyogenic Spondylodiscitis

“… 5 - 7 Orthopedic guidelines with proper algorithms for the management of PS are not universally accepted and usually rely on clinical studies with variable inclusion criteria. 8 - 12 Ideally, a classification system should be easy to apply, inclusive, reproducible, 13 , 14 and if possible, helpful in guiding a treatment option with recommendations.…”