Neurosurgical Management and Outcome Parameters in 237 Patients with Spondylodiscitis

Abstract

Surgical treatment of spondylodiscitis allows for rapid mobilization and shortens hospital stays, which makes surgical treatment the first-line therapy. We aim to describe our experiences with operative treatment on spondylodiscitis and to determine the parameters that are important in the prediction of outcomes. A retrospective review identified 237 patients who were operatively treated for spondylodiscitis in our institution between January 2010 and December 2018. Clinical data were collected through review of electronic records and relevant imaging. In all cases, contrast-enhancing MRI from the infected region of the spine was obtained. Leukocyte count and C-reactive protein concentrations (CRP) were determined in all the patients. We included 237 patients in the study, 87 female (36.7%) and 150 male (63.3%), with a mean age of 71.4 years. Mean follow-up was 31.6 months. Forty-five patients had spondylodiscitis of the cervical, 73 of the thoracic, and 119 of the lumbosacral spine. All the patients with spondylodiscitis of the cervical spine received instrumentation. In thoracic and lumbar spine decompression, surgery without instrumentation was performed in 26 patients as immediate surgery and in a further 28 patients in the early stages following admission, while 138 patients received instrumentation. Eighty-nine patients (37.6%) had concomitant infections. Infection healing occurred in 89% of patients. Favorable outcomes were noted in patients without concomitant infections, with a normalized CRP value and in patients who received antibiotic therapy for more than six weeks (p < 0.05). Unfavorable outcomes were noted in patients with high CRP, postoperative spondylodiscitis, and recurrent spondylodiscitis (p < 0.05). Application of antibiotic therapy for more than six weeks and normalized CRP showed a correlation with favorable outcomes, whereas concomitant infections showed a correlation with unfavorable outcomes. A detailed screening for concomitant infectious diseases is recommended.

Pyogenic spinal infections in patients with chronic liver disease: illustrative case and systematic review

“…Madhavan et al, 33 in a systematic review of 212 patients with spondylodiscitis and end-stage renal disease, found a rate of 46% of neurological compromise. Similar to our findings, Pojski c et al, 34 in a review of 237 patients, reported 72% preoperative neurological compromise. Of note, 146 patients (61.6%) had epidural abscess at the time of diagnosis in their series.…”

The Hamburg Spondylodiscitis Assessment Score (HSAS) for Immediate Evaluation of Mortality Risk on Hospital Admission

“…In contrast to image-guided mostly fine-needle biopsies proposed by some groups, we perform transpedicular biopsies which allow better sampling due to a wider diameter. In addition, experienced spine surgeons and haptic feedback might further improve sampling, resulting in a diagnostic rate of 64% in our patient collective [28].…”

Primary spinal infections in patients with solid organ transplant: a systematic literature review and illustrative case

“…Based on large case series, it is known that main microorganisms involved in spondylodiscitis are Mycobacterium tuberculosis and Staphylococcus species. 35,36 Interestingly, in our study, Aspergillus was the most common agent (52%) followed by Staphylococcus species. Vertebral aspergillosis is a relatively rare and often misdiagnosed entity that usually requires long-term antibiotic treatment and surgical treatment.…”