Spondylitis – Spondylodiscitis – an Update

Abstract

Spondylodiscitis is an infection of the intervertebral disc with subsequent infection of the adjacent vertebral bodies. The main causes are 3 pathogen groups: bacteria, particularly tuberculosis pathogens, fungi and parasites. In pyogenic spondylodiscitis, infections with Staphylococcus aureus are the most common, with an incidence of up to 80%. Mortality is around 2 - 3%. Infections with tuberculosis are often associated with psoas and paravertebral abscesses. Neurological deficits are registered in up to 50% of patients. For microbiological diagnostic testing, blood cultures are used for aerobic and anaerobic bacteria. However, histological examination leads significantly more frequently to positive pathogen detection. In tissue samples, results with 16S rRNA PCR results are clearly superior to results from microbiological examination. The MRI exhibits high sensitivity and specificity and is therefore superior to other radiological methods. Elimination of the infection, pain reduction and stabilisation of the spine are the main objectives of any treatment. A standardised antibiotic therapy for spondylodiscitis has not been clearly defined. Pathogen detection is important, with focused antibiotic therapy. Antibiotic therapy should initially be administered intravenously for 2 - 4 weeks. This should be followed by oral administration for 6 - 12 weeks. In the case of antibiotic-resistant infections with neurological deficiencies, it is recommended to perform a surgical procedure, with careful debridement and instrumentation as well as i. v. administered antibiotics for 3 weeks followed by three month oral antibiotic treatment. Surgical procedures are indicated with neurological deficits, progressive increase in spinal deformities, failure of conservative therapy with insufficient pain relief and unreliable pathogen identification. The selection of the surgical procedure should mainly be based on the extent and localisation of bone destruction and the individual circumstances of the patients. The prognosis is good if there is a clear reduction in CRP and ESR in the first few weeks.

Infektionen der Wirbelsäule – Spondylodiszitis

“…Indikation Indikationen zur operativen Therapie sind: ▪ bestehende oder drohende neurologische Defizite, ▪ epidurale oder paravertebrale Abszessformationen mit oder ohne Kompression der neuronalen Strukturen (insbesondere zervikal und thorakal), ▪ spinale Instabilität als Folge knöcherner Defekte, ▪ schwere Kyphosen, ▪ das Versagen einer konservativen Therapie sowie ▪ jede postoperativ auftretende Spondylodiszitis [1,21].…”

“…Prinzipiell steht eine Vielfalt chirurgischer Verfahren zur Verfügung, ohne dass es eine Evidenz für eine allgemeingültige Vorgehensweise gibt [7,21]. Die chirurgische Strategie wird maßgeblich durch das Ausmaß der knöchernen Beteiligung, patientenspezifische Charakteristika und auch durch die Erfahrung des Chirurgen beeinflusst.…”

Minimally invasive debridement and drainage using intraoperative CT-Guide in multilevel spondylodiscitis: a long‐term follow‐up study

“…Spondylodiscitis is an unusual infectious disease, which usually originates as a pathogenic infection of intervertebral discs and then spreads to neighboring vertebral bodies [1]. Mortality is around 2-3 % [2]. Its incidence varies between 0.2 % and 3.6 % after spine surgery [1,3,4].…”

Clinical suspicion of spondylodiscitis with equivocal MRI findings: does diffusion-weighted imaging prove helpful here?

“…Modic I), which can mimic infections, is crucial in determining the appropriate therapeutic approach. Misdiagnosis or a delayed SpD diagnosis can lead to destruction of the adjacent vertebral bodies, which results in instability, neurological deficits, and chronic back pain (1)(2)(3).…”