Predicting the need for surgical intervention in patients with spondylodiscitis: the Brighton Spondylodiscitis Score (BSDS)

Appalanaidu, Nageswary; Shafafy, Roozbeh; Gee, Christopher W; Brogan, Kit; Karmani, S.; Morassi, Giuseppe Lambros; Elsayed, Sherief

doi:10.1007/s00586-018-5775-x

Cited by 24 publications

(36 citation statements)

References 28 publications

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“…22 Thoracic VO is an infection at the level of the spinal cord which must be considered more severe than VO at the level of the cauda equina (lumbar level). The findings by Appalanaidu et al 23 corroborate our findings-thoracic and thoracolumbar infection indicated more severe disease. CRP normalization will be delayed after surgery due to the surgical trauma.…”

Section: Discussionsupporting

confidence: 90%

Vertebral Osteomyelitis: A Mortality Analysis Comparing Surgical and Conservative Management

Zadran

Pedersen

Eiskjær

2019

Global Spine Journal

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Study Design: Retrospective cohort study. Objectives: To compare the mortality between patients treated for vertebral osteomyelitis (VO) with either surgical or conservative management and to construct a predictive model for mortality after VO. Methods: All patients with a diagnosis of VO in Region North Denmark from 2004 to 2014 were followed for at least 2 years or until death. They were all treated according to a standardized guideline for the choice of treatment modality. Nineteen dichotomized variables with possible influence on the mortality were registered for all patients in the study. LASSO (least absolute shrinkage and selection operator) penalized Cox regression analysis was used to build a predictive model for 2-year survival after VO. Results: A total of 125 patients were eligible for inclusion, mean age 67 years, 36 women. 75 were treated surgically. Twenty-one patients were dead 2 years after the diagnosis. Kaplan-Meier estimate of 2-year survival was 0.82 [0.75, 0.88]. Any difference in mortality between surgically and conservatively treated patients was nonsignificant at 1 and 2 years (univariate Cox regression analysis). Significant factors included in the predictive model after LASSO penalized Cox regression analysis was Charlson Comorbidity Index (CCI), cardiovascular disease, C-reactive protein (CRP) normalization, thoracic infection, and Karnofsky score. The area under the curve (AUC) for the predictive model ranged from 0.74 to 0.77. Conclusion: Patients undergoing surgical management for vertebral osteomyelitis according to standardized and agreed-upon guidelines had no higher mortality than those allocated to conservative treatment. The predictive model included 5 variables associated with an increased mortality: CCI, CRP normalization, cardiovascular disease, thoracic infection, and Karnofsky score.

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Section: Discussionsupporting

confidence: 90%

Vertebral Osteomyelitis: A Mortality Analysis Comparing Surgical and Conservative Management

Zadran

Pedersen

Eiskjær

2019

Global Spine Journal

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“…In 28 of 211 patients (13.3%), the determination of the pathogen was only possible through blood cultures, which underlines the great importance of the blood cultures for MSSA was the most commonly detected pathogen, in both intraoperative (31%) and blood cultures (36.7%), followed by S. epidermidis, as has been found in previous studies (28-55%) [13][14][15][16][17].…”

Section: Discussionsupporting

confidence: 53%

Influence of microbiological diagnosis on the clinical course of spondylodiscitis

et al. 2021

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Purpose This study sought to recognize differences in clinical disease manifestations of spondylodiscitis depending on the causative bacterial species. Methods We performed an evaluation of all spondylodiscitis cases in our clinic from 2013–2018. 211 patients were included, in whom a causative bacterial pathogen was identified in 80.6% (170/211). We collected the following data; disease complications, comorbidities, laboratory parameters, abscess occurrence, localization of the infection (cervical, thoracic, lumbar, disseminated), length of hospital stay and 30-day mortality rates depending on the causative bacterial species. Differences between bacterial detection in blood culture and intraoperative samples were also recorded. Results The detection rate of bacterial pathogens through intraoperative sampling was 66.3% and could be increased by the results of the blood cultures to a total of 80.6% (n = 170/211). S. aureus was the most frequently detected pathogen in blood culture and intraoperative specimens and and was isolated in a higher percentage cervically than in other locations of the spine. Bacteremic S. aureus infections were associated with an increased mortality (31.4% vs. overall mortality of 13.7%, p = 0.001), more frequently developing complications, such as shock, pneumonia, and myocardial infarction. Comorbidities, abscesses, length of stay, sex, and laboratory parameters all showed no differences depending on the bacterial species. Conclusion Blood culture significantly improved the diagnostic yield, thus underscoring the need for a structured diagnostic approach. MSSA spondylodiscitis was associated with increased mortality and a higher incidence of complications.

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“…These were all patients of advanced age (over 85 years old) with several concomitant diseases and who were in a reduced general condition. The recently developed Brighton Spondylodiscitis Score (BSDS) helps to identify patients with spondylodiscitis who would fail non-operative management and would benefit from early surgery [25]. Immune-compromised patients with comorbidities and concomitant diseases, such as endocarditis as well as signs of vertebral collapse and the presence of motoric neurological deficits, have been identified as high risk patients that require surgical interventions [25].…”

Section: Conservative Vs Operative Treatment Of Spondylodiscitismentioning

confidence: 99%

Neurosurgical Management and Outcome Parameters in 237 Patients with Spondylodiscitis

et al. 2021

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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.

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Predicting the need for surgical intervention in patients with spondylodiscitis: the Brighton Spondylodiscitis Score (BSDS)

Cited by 24 publications

References 28 publications

Vertebral Osteomyelitis: A Mortality Analysis Comparing Surgical and Conservative Management

Vertebral Osteomyelitis: A Mortality Analysis Comparing Surgical and Conservative Management

Influence of microbiological diagnosis on the clinical course of spondylodiscitis

Neurosurgical Management and Outcome Parameters in 237 Patients with Spondylodiscitis

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