Early surgery may lower mortality in patients suffering from severe spinal infection

Lener, Sara; Wipplinger, Christoph; Stocsits, Anna; Hartmann, Sébastian; Hofer, Anja; Thomé, Claudius

doi:10.1007/s00701-020-04507-2

Cited by 10 publications

(11 citation statements)

References 30 publications

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“…In a retrospective study, Lener et al reported that the operative cohort had lower mortality rates than the conservative cohort (6% versus 18%) 8 . As a result, the authors recommended early surgical treatment, particularly in patients with septicaemia or progressive spinal infection 8 .…”

Section: Timing Of Surgical Interventionmentioning

confidence: 99%

“…Generally, patient outcome is directly correlated with the disease severity and the time between diagnosis and actual treatment [7]. In a retrospective study, Lener et al reported that the operative cohort had lower mortality rates than the conservative cohort (6 % versus 18 %) [8]. As a result, the authors recommended early surgical treatment, particularly in patients with septicaemia or progressive spinal infection [8].…”

Section: Timing Of Surgical Interventionmentioning

confidence: 99%

“…Generell besteht ein direkter Zusammenhang zwischen der Schwere der Erkrankung, der Zeit zwischen Diagnosefindung und eigentlicher Therapieeinleitung und dem Outcome des Patienten [7]. Lener et al zeigten in ihrer retrospektiven Arbeit geringere Mortalitätsraten in der operativen im Vergleich zur konservativen Kohorte (6 % vs. 18 %) [8]. Die Autoren empfahlen daraufhin besonders bei Patienten mit septischem Krankheitsbild oder fortschreitender spinaler Infektion eine frühe operative Behandlung [8].…”

Section: Zeitpunkt Der Operativen Interventionunclassified

“…Lener et al zeigten in ihrer retrospektiven Arbeit geringere Mortalitätsraten in der operativen im Vergleich zur konservativen Kohorte (6 % vs. 18 %) [8]. Die Autoren empfahlen daraufhin besonders bei Patienten mit septischem Krankheitsbild oder fortschreitender spinaler Infektion eine frühe operative Behandlung [8].…”

Section: Zeitpunkt Der Operativen Interventionunclassified

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Surgical Treatment Strategies for Pyogenic Spondylodiscitis of the Thoracolumbar Spine

et al. 2021

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Background Despite advances, the morbidity and mortality rates of patients with spondylodiscitis remains high, with an increasing incidence worldwide. Although conservative therapy has progressed, several cases require surgical intervention. However, the indication and opportunities for surgical treatment are still disputable. Methods In a joint consensus, the members of the ‘Spondylodiscitis’ working group of the Spine Section of the German Society for Orthopaedics and Trauma Surgery considered current literature, particularly the newly published S2k guideline of the AWMF, and examined the surgical indications and treatment strategies for thoracolumbar spondylodiscitis. Results Surgical intervention for spondylodiscitis is only required in a small percentage of patients. In studies comparing conservative and surgical therapies, most patients benefitted from surgery, regardless of the surgical technique selected. Presently, the standard procedure is a combined dorsoventral approach, in which a monolateral attempt should always be made. The choice of material (PEEK, titanium) for ventral support does not influence the clinical result.

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Section: Timing Of Surgical Interventionmentioning

confidence: 99%

Section: Timing Of Surgical Interventionmentioning

confidence: 99%

Section: Zeitpunkt Der Operativen Interventionunclassified

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Surgical Treatment Strategies for Pyogenic Spondylodiscitis of the Thoracolumbar Spine

et al. 2021

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“…PSD can be treated conservatively or surgically [ 3 , 4 ], and can affect a single level or multiple levels. Patients benefit from early surgical treatment of PSD and spinal infection [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Early fusion outcome after surgical treatment of single-level and multi-level pyogenic spondylodiscitis: experience at a level 1 center for spinal surgery—a single center cohort study

et al. 2023

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Study design Retrospective single center cohort study. Purpose Spinal instrumentation in combination with antibiotic therapy is a treatment option for acute or chronic pyogenic spondylodiscitis (PSD). This study compares the early fusion outcome for multi-level and single-level PSD after urgent surgical treatment with interbody fusion in combination with fixation. Methods This is a retrospective cohort study. Over a 10 year period at a single institution, all surgically treated patients received surgical debridement, fusion und fixation of the spine to treat PSD. Multi-level cases were either adjacent to each other on the spine or distant. Fusion rates were assessed at 3 and 12 months after surgery. We analyzed demographic data, ASA status, duration of surgery, location and length of spine affected, Charlson comorbidity index (CCI), and early complications. Results A total of 172 patients were included. Of these, 114 patients suffered from single-level and 58 from multi-level PSD. The most frequent location was the lumbar spine (54.0%) followed by the thoracic spine (18.0%). The PSD was adjacent in 19.0% and distant in 81.0% of multi-level cases. Fusion rates at the 3 month follow-up did not differ among the multi-level group (p = 0.27 for both adjacent and distant sites). In the single-level group, sufficient fusion was achieved in 70.2% of cases. Pathogen identification was possible 58.5% of the time. Conclusions Surgical treatment of multi-level PSD is a safe option. Our study demonstrates that there was no significant difference in early fusion outcomes between single-level and multi-level PSD, whether adjacent or distant.

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Surgical treatment of spondylodiscitis in critically ill septic patients

Al-Afif,

Atallah,

Scheinichen

et al. 2023

Acta Neurochir

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Purpose Surgical procedures in critically ill patients with spondylodiscitis are challenging and there are several controversies. Here, we present our experience with offering surgical intervention early in critically ill septic patients with spondylodiscitis. Method After we introduced a new treatment paradigm offering early but limited surgery, eight patients with spondylodiscitis complicated by severe sepsis and multiple organ failure underwent urgent surgical treatment over a 10-year period. Outcome was assessed according to the Barthel index at 12-month follow-up and at the last available follow-up (mean 89 months). Results There were 7 men and 1 woman, with a mean age of 62 years. The preoperative ASA score was 5 in 2 patients, and 4 in 6 patients. Six of them presented with high-grade paresis, and in all of them, spondylodiscitis with intraspinal and/or paravertebral abscesses was evident in MR imaging studies. All patients underwent early surgery (within 24 h after admission). The median time in intensive care was 21 days. Out of the eight patients, seven survived. One year after surgery, five patients had a good outcome (Barthel index: 100 (1); 80 (3); and 70 (1)). At the last follow-up (mean 89 months), 4 patients had a good functional outcome (Barthel index between 60 and 80). Conclusion Early surgical treatment in critically ill patients with spondylodiscitis and sepsis may result in rapid control of infection and can provide favorable long-term outcome. A general strategy of performing only limited surgery is a valid option in such patients who have a relatively high risk for surgery.

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Early surgery may lower mortality in patients suffering from severe spinal infection

Cited by 10 publications

References 30 publications

Surgical Treatment Strategies for Pyogenic Spondylodiscitis of the Thoracolumbar Spine

Surgical Treatment Strategies for Pyogenic Spondylodiscitis of the Thoracolumbar Spine

Early fusion outcome after surgical treatment of single-level and multi-level pyogenic spondylodiscitis: experience at a level 1 center for spinal surgery—a single center cohort study

Surgical treatment of spondylodiscitis in critically ill septic patients

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