gms | German Medical Science

Objective: Regarding pyogenic vertebral infections most papers deal with risk factors, clinical and diagnostic findings and discuss management strategies. But the final strategy remains controversial and outcome data regarding quality of life are sparse.

Methods: We retrospectively evaluated 62 patients (35 men, 27 women, 64.3 years, mean). We registrated the clinical and neurological symptoms, the diagnostic imaging, the laboratory investigations, the antibiotic and surgical treatment. The follow-up was done in 42 patients after 16.4 month (range 1-46) due to a standard protocoll including the SF 36 health survey. Eleven patients (17%) could not be followed up due to unknown address and nine died.

Results: Most patients showed a lumbar lesion (n=37), nineteen a thoracic and thoracolumbar affection, 6 patients an infection of the cervical spine. 20 showed an infection involving the vertebral disc and body, as well as the epidural and paravertebral space. 45% (n=28) were treated conservatively, 55% (n=34) had surgery with and without instrumentation. Indication for surgery was mostly given due to instability of the spine (n=21). There was a tendency that the patients in the surgical group showed a more extended infection (p=0.08). Regarding the SF 36 in none of the categories the mean outcome value reached the level of the norm sample. There was a tendency that the operated patients scored in some categories better than the group of patients with conservative treatment. 31% (n=13) reached unfavourable outcome (unchanged or worsened complaints), 69% (n=29) reached favourable outcome (no or improved complaints). Patients who had surgery showed a better outcome compared to the conservative group regarding the overall outcome. 10 out of 13 patients (77%) with unfavourable had no surgery compared to 22 patients out of 29 patients (76%) with favourable outcome who had surgery (p<0.0013). Patients with spinal instrumentation do far better than patients in the conservative group. 17 out of 20 patients with instrumentation showed a favourable outcome (85%), compared to 7 out of 17 patients in the conservative group (41%, p<0.0045).

Conclusions: Despite different indications the surgically treated patients showed regarding the quality of life a slightly better and regarding the patients satisfaction a significantly better outcome compared to the conservative group. We therefore think that surgery especially instrumentation should be the preferred treatment option.