Increased short- and long-term mortality among patients with infectious spondylodiscitis compared with a reference population

Kehrer, Michala; Pedersen, Court; Jensen, Thøger Gorm; Hallas, Jesper; Lassen, Annmarie Touborg

doi:10.1016/j.spinee.2015.02.021

Cited by 76 publications

(93 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It is a life-threatening and serious disease with high mortality rates [2]. Surgery for lumbar spondylodiscitis is indicated for neurological deficits, instability, deformity, medically intractable pain, or disease progression [3,4].…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive spine surgery in lumbar spondylodiscitis: a retrospective single-center analysis of 67 cases

et al. 2017

View full text Add to dashboard Cite

Background Minimally invasive surgical techniques have been developed to minimize tissue damage, reduce narcotic requirements, decrease blood loss, and, therefore, potentially avoid prolonged immobilization. Thus, the purpose of the present retrospective study was to assess the safety and efficacy of a minimally invasive posterior approach with transforaminal lumbar interbody debridement and fusion plus pedicle screw fixation in lumbar spondylodiscitis in comparison to an open surgical approach. Furthermore, treatment decisions based on the patients preoperative condition were analyzed. Methods 67 patients with lumbar spondylodiscitis treated at our department were included in this retrospective analysis. The patients were categorized into two groups based on the surgical procedure: group (MIS) minimally invasive lumbar spinal fusion (n = 19); group (OPEN) open lumbar spinal fusion (n = 48). Evaluation included radiological parameters on magnetic resonance imaging (MRI), laboratory values, and clinical outcome. Results Preoperative MRI showed higher rates of paraspinal abscess (35.5 vs. 5.6%; p = 0.016) and multilocular location in the OPEN group (20 vs. 0%, p = 0.014). Overall pain at discharge was less in the MIS group: NRS 2.4 ± 1 vs. NRS 1.6 ± 1 (p = 0.036). The duration of hospital stay was longer in the OPEN than the MIS group (19.1 ± 12 days vs. 13.7 ± 5 days, p = 0.018). Conclusion The open technique is effective in all varieties of spondylodiscitis inclusive in epidural abscess formation. MIS can be applied safely and effectively as well in selected cases, even with epidural abscess.

show abstract

Section: Introductionmentioning

confidence: 99%

Minimally invasive spine surgery in lumbar spondylodiscitis: a retrospective single-center analysis of 67 cases

et al. 2017

View full text Add to dashboard Cite

show abstract

“…3,5,6,10,12,16,19,25 A considerable number of patients had comorbidities consistent with the literature. 3,4,8,15 The predominant pathogen was S. aureus, but in a large number of patients no Most studies report overall mortality, even though this strongly correlates to the length of follow-up. 15 The 1-year crude mortality rate in our study was comparable with the 4.8% reported by Woertgen et al, 16 but less than a recent large-scale registry study on a Danish population.…”

Section: Discussionmentioning

confidence: 99%

“…3,4,8,15 The predominant pathogen was S. aureus, but in a large number of patients no Most studies report overall mortality, even though this strongly correlates to the length of follow-up. 15 The 1-year crude mortality rate in our study was comparable with the 4.8% reported by Woertgen et al, 16 but less than a recent large-scale registry study on a Danish population. 15 The high mortality rate (20%) in the latter study was possibly due to an older study population and inclusion of patients who were too critically ill to be referred to a tertiary hospital.…”

Section: Discussionmentioning

confidence: 99%

“…Overall, there is no evidence of increased mortality in surgically treated spondylodiscitis patients compared with those treated conservatively. 4,8,15,16 The high rate of mortality and morbidity seen in spondylodiscitis patients is likely multifactorial. Our study did not find an association between CCI score and adverse morbidity outcome (Table 3).…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][9][10][11][12] In most cases, stabilization with spinal implants is necessary, and in spite of the infectious nature of the condition, most studies report a low risk of recurring infection. 5,6,10,13,14 The overall mortality of spondylodiscitis is 5-10%, [2][3][4]7,15 but studies reporting outcome after surgical treatment are scarce, and few studies have reported the health-related quality of life (HRQL) after surgery. [16][17][18][19][20] A few studies have shown that a preoperative neurological deficit is a predictor of a negative outcome, 4,8,9 and neurological deficits are more often present when the spinal infection affects the cervical or thoracic regions.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Mortality and health-related quality of life in patients surgically treated for spondylodiscitis

Dragsted

Aagaard

Ohrt-Nissen

et al. 2017

Journal of Orthopaedic Surgery

View full text Add to dashboard Cite

Mortality and health-related quality of life in patients surgically treated for spondylodiscitis Dragsted, Casper; Aagaard, Theis; Ohrt-Nissen, Søren; Gehrchen, P.M.; Dahl, Benny To assess mortality, disability, and health-related quality of life (HRQL) in patients surgically treated for spondylodiscitis. Methods: A retrospective longitudinal study was conducted on all patients surgically treated for spondylodiscitis over a 6-year period at a single tertiary spine center. Indications for surgery, pre-and postoperative neurological impairment, comorbidities, and mortality were recorded. A survey was conducted on all eligible patients with the EuroQol 5-dimension (EQ-5D) questionnaire and Oswestry Disability Index (ODI). Results: Sixtyfive patients were diagnosed with spondylodiscitis not related to recent spine surgery. One-year mortality rate was 6%. In all, 36% and 27% had pre-and postoperative neurological impairment, respectively, with only one patient experiencing deterioration postoperatively. At final follow-up (median 2 years), mean ODI was 31% (SD ¼ 22) and mean EQ-5D time trade-off score was 0.639 (SD ¼ 0.262); this was significantly lower than that in the normal population (p < 0.001). Patients with neurological impairment prior to index surgery had lower EQ-5D scores (p ¼ 0.005) and higher ODI (p ¼ 0.02) at final follow-up compared with patients without neurological impairment. Conclusions: Several years after surgery, patients surgically treated for spondylodiscitis have significantly lower HRQL and more disability than the background population. Neurological impairment prior to index surgery predicts adverse outcome in terms of disability and lower HRQL.

show abstract

Septische Arthritis und Spondylodiszitis

Jung

Vossen

2016

Z Rheumatol

View full text Add to dashboard Cite

Septic arthritis and spondylodiscitis are relatively rare but severe diseases with increasing incidence. Septic arthritis is an emergency situation with high morbidity (40 %) and fatality rates (11 %). The infection occurs via a hematogenous route by direct inoculation or per continuitatem. Patients with pre-existing destructive joint diseases or under immunosuppressive treatment are particularly at risk. It is mandatory to sample synovial fluid for isolation of the relevant pathogen and quantification of leucocytes before starting antibiotic therapy. In order to preserve the joint, early evacuation of the infected synovial space is necessary. Spondylodiscitis is characterized by infection of the vertebra and neighboring discs mainly via a hematogenous route. Immunosuppressed and older patients are primarily at risk of infection. Back pain represents the main symptom but due to its unspecific character and the frequent absence of fever, diagnosis is often delayed. In Europe Staphylococcus aureus is the most prevalent pathogen, whereas tuberculosis is the most frequent causal agent worldwide. Magnetic resonance imaging (MRI) respresents the method of choice for the radiological diagnostics. In stable patients isolation of the pathogen should be achieved before starting antimicrobial therapy (e.g. blood cultures or tissue samples by computed tomography guided puncture or biopsy). The recommended duration of pathogen-specific antibiotic therapy for native spondylodiscitis is normally 6 weeks.

show abstract

Increased short- and long-term mortality among patients with infectious spondylodiscitis compared with a reference population

Cited by 76 publications

References 16 publications

Minimally invasive spine surgery in lumbar spondylodiscitis: a retrospective single-center analysis of 67 cases

Minimally invasive spine surgery in lumbar spondylodiscitis: a retrospective single-center analysis of 67 cases

Mortality and health-related quality of life in patients surgically treated for spondylodiscitis

Septische Arthritis und Spondylodiszitis

Contact Info

Product

Resources

About