Spondylodiscitis. A retrospective study of 163 patients

Abstract

Background and purpose Spondylodiscitis may be a serious disease due to diagnostic delay and inadequate treatment. There is no consensus on when and how to operate. We therefore retrospectively analyzed the outcome of a large series of patients treated either nonoperatively or surgically.Patients and methods Between 1992 and 2000, 163 patients (101 males) were hospitalized due to spondylodiscitis. The mean age was 56 (1-83) years. The infection was located in the cervical spine in 13 patients (8%), in the thoracic spine in 62 patients (38%), at the thoracolumbar junction in 10 patients (6%), and in the lumbo-sacral spine in 78 patients (48%). In 67 patients (41%), no microorganisms were detected. Most of the other patients had Staphylococcus aureus infection (53 patients) and/or Mycobacterium tuberculosis (22 patients). The patients were divided into 3 groups: (A) 70 patients who had nonoperative treatment, (B) 56 patients who underwent posterior decompression alone, and (C) 37 patients who underwent decompression and stabilization.Results At 12-month follow-up, nonoperative treatment (A) had failed in 8/70 patients, who had subsequently been operated. 24/56 and 6/37 had been reoperated in groups B and C, respectively. Group A patients had no neurological symptoms. In group B, 11 had neurological deficits and surgery was beneficial for 5 of them; 4 remained unchanged and 2 deteriorated (1 due to cerebral abscess). 11 patients in group C had altered neurogical deficits, which improved in 9 of them. 20 patients had died during the 1-year follow-up, 3 in hospital, directly related with infection.

Failure modes in conservative and surgical management of infectious spondylodiscitis

“…After exclusion of 8 patients with spinal metastases or primary tumors, 2 with fungal, and 13 with tuberculous spondylodiscitis, we were left with a study population of 196 patients. Our study is quite similar to our previous study by Karadimas et al [12] that was based on 163 patients (of these 22 had tuberculous and one fungal spondylodiscitis) treated during an 8-year period from 1992 to 2000. We noted as did Karadimas that the disease primarily affects middle-aged males (mean age 59 years), and more than 60 % of our population had several risk factors and a series of concomitant diseases.…”

“…The same tendencies were found by Karadimas et al [12] and by other authors [1,2,5,8]. We found no relation between specific infectious microorganism and the quantity or spectrum of complications, nor did specific organisms present special treatment challenges.…”

“…In the previous study by Karadimas et al [12], 61.9 % of patients needed surgery; in our population, 117 (59.6 %) patients underwent surgery. Posterior decompression alone was done in 19 (16.2 %) cases.…”

“…Twelve patients needed surgery, and thus conservative treatment failed in 13.1 % of patients. Karadimas et al [12] noted 17.1 % failures among patients managed non-surgically; other authors have reported failure rates from 12 to 16 % [1,4,7]. We had three in-hospital deaths in this group.…”

“…We present the experience based on 10-year period, from 2000 to 2010. Furthermore, we discuss the changes in our strategies and treatment that have taken place since the study by Karadimas et al [12] that reviewed the treatment of spondylodiscitis treated at our clinic between 1992 and 2000.…”