Surgical treatment of spondylodiscitis in the cervical spine: a minimum 2-year follow-up

Abstract

Cervical spine spondylodiscitis is a rare, but serious manifestation of spinal infection. We present a retrospective study of 20 consecutive patients between 01/1994 and 12/1999 treated because of cervical spondylodiscitis. Mean age at the time of treatment was 59.7 (range 34-81) years, nine of them female. In all cases, diagnosis had been established with a delay. All patients in this series underwent surgery such as radical debridement, decompression if necessary, autologous bone grafting and instrumentation. Surgery was indicated if a neurological deficit, symptoms of sepsis, epidural abscess formation with consecutive stenosis, instability or severe deformity were present. Postoperative antibiotic therapy was carried out for 8-12 weeks. Follow-up examinations were performed a mean of 37 (range 24-63) months after surgery. Healing of the inflammation was confirmed in all cases by laboratory, clinical and radiological parameters. Spondylodesis was controlled radiologically and could be achieved in all cases. One case showed a 15°kyph-otic angle in the proximal adjacent segment. Spontaneous bony bridging of the proximal adjacent segment was observed in one patient. In the other cases the adjacent segments radiologically showed neither fusion nor infection related changes. Preoperative neurological deficits improved in all cases. Residual neurological deficits persisted in three of eight cases. The results indicate that spondylodiscitis in cervical spine should be treated early and aggressive to avoid local and systemic complications.

Treatment of spondylodiscitis

“…In 75% of patients with acute paraplegia, ambulation was restored after therapy [4]. Similar results can be found in other published studies [2,3,38]. Overall, a relapse of spondylodiscitis is unlikely to occur.…”

“…Bi-or polysegmental infections may require posterior-anterior stabilisation. Postoperatively, the patient should wear a semi-rigid cervical collar for four to six weeks [38].…”

Successful treatment of spondylodiscitis using titanium cages: A 3-year follow-up of 22 consecutive patients

“…The primary goal of surgical therapy is complete debridement with radical removal of any infectious or necrotic tissue (Heyde et al 2006). Then adequate stabilization is necessary, which mostly implies a 360-degree fusion including bone grafting (Ruf et al 2007).…”

“…Thus, more and more spinal surgeons implant metal devices into the infected spine to avoid secondary deformity, regardless of the bacterial adherence that has sometimes been reported. Several authors have recently presented favorable results regarding healing and avoidance or correction of deformity using titanium implants (Heyde et al 2006, Kuklo et al 2006, Ruf et al 2007. In large anterior defects after severe spondylitis, the use of anterior titanium cages is especially advantagious in reconstruction of the sagittal alignment (Robinson et al 2008).…”

Complex 360°-reconstruction and stabilization of the cervical spine due to osteomyelitis

“…Anterior debridement and spondylodesis seem to be sufficient in cases without instability and severe deformity [6,10,13], but multisegmental involvement or distinct substance loss requires a combined anterior-posterior approach [10,13,23,24]. Most of these reports deal with the thoracic and lumbar spine, but results may be transferred to the cervical spine too [1,2,10,24].…”