Artikel
Treatment and long-term outcome of patients with spinal infections
Behandlung und klinischer Langzeitverlauf von Patienten mit spinaler Infektion
Suche in Medline nach
Autoren
-
E. Uhl
- Neurochirurgische Klinik, Ludwig-Maximilians-Universität, München
-
M. Sagastegui
- Neurochirurgische Klinik, Ludwig-Maximilians-Universität, München
-
S. Zausinger
- Neurochirurgische Klinik, Ludwig-Maximilians-Universität, München
| Veröffentlicht: | 8. Mai 2006 |
|---|
Gliederung
Text
Objective: To evaluate retrospectively short- and long-term outcome of patients treated for spinal infections and to determine prognostic factors.
Methods: 84 consecutively treated patients (1996-2004) with spinal infections (42 with spondylodiscitis, 42 with epidural abscess) were included. Patients were either treated conservatively or by surgery depending on osseous morphology and neurological status. Among other parameters preoperative neurological symptoms (e.g. paresis, vegetative disturbances), bacterial pathogens, duration of antibiotic treatment and neuroradiological parameters were investigated. Clinical outcome (neurological deficit, Barthel-index) was rated at discharge and at long-term follow-up.
Results: Mean age of patients was 60±17 years (45 m, 39 f). 23 patients were treated conservatively, 61 underwent surgery for exploration of the infectious process. Staph. aureus was the most common pathogen and found in 42 cases, no pathogen was detected in 11 cases. 25/84 patients had previous spinal surgery in close temporal relationship to development of infection (median: 5 weeks), 13 patients had other foci, in 40 no obvious cause for the infection was found. CRP was elevated in 96% of cases. Mean duration of antibiotic treatment was 25±9 days. Diabetes mellitus and adipositas (elevated body mass index >25) were found in 29% and 49% of the patients, respectively. Median follow-up time was 239 weeks. Four patients died during the acute phase (sepsis), another 14 during the follow-up period but only one death was related to spinal infection (endocarditis). Of the remaining patients median Barthel-index was 100 points (range 25-100) indicating good recovery concerning activities of daily life. However, according to subjective estimation 42% patients considered their outcome as bad to moderate and 58% as good/excellent. A major problem reported was chronic pain.
Conclusions: Despite modern antibiotics spinal infections remain a serious and challenging disease requiring long-term antibiotic treatment. Although most patients regain normal daily activities some are left with relevant neurological deficits and chronic pain. Treatment concepts are still controversely discussed especially immobilisation which remains a major problem especially in elderly patients.
