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

Abstract

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.

Neurosurgical Management and Outcome Parameters in 237 Patients with Spondylodiscitis

“…One recent study found that the identification of the pathogen could only have been conducted in 22.4% of the patients with pyogenic spondylodiscitis [47]. Postoperative antibiotic therapy was managed against the result of the susceptibility test, or was empirically given to patients with negative cultures with all antibiotic therapy IV initiated for 4-6 weeks and orally for 6 weeks [47].…”

Spondylodiscitis in Children: A Retrospective Study and Comparison With Non-vertebral Osteomyelitis

“…At the moment of writing, no guidelines for the conservative and surgical treatments of PSD are yet available. Thus, the current pediatric practice is derived from the management of adult spondylodiscitis (12)(13)(14) and relies upon the experience of the treating clinicians. After clinical suspicion of PSD is risen, contrast-enhanced magnetic resonance imaging is the investigation of choice for the description of the infected site location and extension (3).…”

Osteomyelitis of the spine: treatments and future directions

“…The average operating time is 162.9-375 minutes, average blood loss is 1152-1470 mL, the average corrected lordotic angle is 6.1 ± 10.3°, and the average stay in the spine unit is 30 days [ 33 ]. Many patients experience immediate relief of pain and reduction of fever, and the anterior approach minimizes the damage done to the paraspinal muscles and bones [ 34 ]. However, 10% have infection recurrence, 6.3% require revision surgery, and 14.6% of patients die [ 33 ].…”

“…This procedure is most often used when the thoracic spine is involved and/or an epidural abscess is present [ 38 ]. The spinal process and laminae are removed, followed by the removal of the diseased vertebrae [ 34 ]. A PEEK bone graft cage is then placed.…”

“…The average operating time is 123 min, average corrected lordotic angle is 4.3° ± 8.4°, and the average blood loss is 679 mL [ 40 ]. The posterior approach enables rigid fixation through the placement of pedicle screws [ 34 ].…”